Asked why it has taken obstetricians and the hospitals where they deliver babies so long to recognize the problem, and adjust their practices, Nash explained that for many years, the phrase "carried to term" meant to 37 weeks.
Now, he said, there's much more awareness of the dramatic changes in the neonate between 37 and 39 weeks, especially in the neurologic development of the infant. "One argues that neurologic development could take place in the neonatal intensive care unit as well as in utero," he said. "But believe me, over and over again, we have found out that the best place for the neonate to develop normally, with the best advantage, is in utero."
"It's been an accumulation of evidence of neonatal harm that gave us the wakeup call."
While more hospitals are providing data to Leapfrog's obstetric report, Binder laments that not enough hospitals are willing to be transparent. She says only about one-third of hospitals offering obstetric services now report their rates of early elective deliveries. The other two-thirds just don't want to, she said, or complain that they think the 40 to 80 hours of staff time it takes to compile the survey data is too much.
"That's a lot less than any other reporting instrument we know of, a lot less, but for many hospitals it's more than they wish to commit to."
"I have to be frank," she continued. "We have good evidence behind the scenes that for many hospitals, the issue of transparency is a hard one. They are not accustomed to publicly reporting data, like early elective deliveries, for all to see.
"But I think hospitals are entering a new era of transparency, which is why we're seeing more interest." Binder advises patients and community members to "be assertive in saying that 'we do expect to hear this information from our hospitals before we entrust our lives in their care.' "
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