Nature knows better than man when a baby should be born.
After two decades in which doctors increasingly used drugs to prompt labor and delivery, they have begun to back away from that practice.
Birthing hospitals in Lincoln and Des Moines have agreed to allow no induction of labor — typically, the use of chemicals to begin a pregnant woman's labor and delivery — before 39 weeks of pregnancy, unless there is a medical reason to do so.
The head of a committee in Omaha's metro area said hospitals here generally have policies discouraging elective induction of labor before 39 weeks. The committee hopes to form a citywide panel of medical practitioners who would meet with any doctor who failed to comply, inform him of the importance of compliance, and consider undetermined "additional measures" if necessary.
Research has found that babies that remain in their mother for 39 weeks or more face fewer complications than those who are induced at 37 or 38 weeks. But doctors induced labor more and more through the 1990s and 2000s. They did so because moms felt miserable near the end of their pregnancies, or because a relative would be in town for the birth, or because the obstetrician was about to go on vacation.
"We lost track of what was best for the baby," said Deb Chambers, director of perinatal services at St. Elizabeth Regional Medical Center in Lincoln.
National organizations such as the March of Dimes and the Institute of Healthcare Improvement began last decade to push against inducing labor early for convenience. Among studies on the subject, one found that 15.2 percent of elective inductions at 37 to 38 weeks involved a stay in the neonatal intensive care unit for the baby, compared with only 6 percent of elective inductions after 39 weeks.
Chelsey Erpelding of Omaha expects to have her labor induced this week. She's 39 weeks pregnant and also has a family history of a blood-clotting disorder that increases the risk involved in labor and delivery. For both reasons, she said, she falls within the appropriate criteria for induction.
Erpelding said she has been pelted with information online and elsewhere about the importance of waiting 39 weeks before induction. "I think that if I had a choice, I would have wanted my baby to come out in her own time," she said.
The Omaha committee, made up of about 20 doctors and nurses from metro-area hospitals, began meeting on an occasional basis a little more than a year ago. Rosemary Opbroek, Nebraska director of the March of Dimes, said she would like a "hard stop" placed on elective inductions before 39 weeks.
A hard stop would ban inductions before 39 weeks that aren't performed for medical reasons, such as vaginal bleeding, abnormal fetal heart rate and a baby's failure to grow normally. Cesarean sections that aren't done for medical reasons are being viewed similarly.
Lincoln's two birthing hospitals, St. Elizabeth and BryanLGH, agreed four years ago to put a hard stop on elective induction before 39 weeks. Hospital representatives informed the medical community and put a message on a billboard to tell the public.
"It was the right thing to do, and we did it as a community initiative," Chambers said. "Our culture has been changed. It worked out great."
Gregg Lagan, a spokesman for Mercy Medical Center-Des Moines, said the five birthing hospitals in the Des Moines area reached an agreement about two years ago to cease elective induction before 39 weeks.
It's important that all hospitals in a community sign on. Otherwise physicians could play one hospital against another or patients could choose physicians on the basis of who would be willing to induce early, said Dr. Stephen Feltz, a Des Moines obstetrician-gynecologist.
"Unfortunately, hospitals do compete for patients," Feltz said.
It's not clear if each Omaha hospital is equally vigilant in curbing inductions for convenience. Dr. Carl Smith, chief of obstetrics at the Nebraska Medical Center, said through an email: "It is safe to assume that the issue is not completely resolved at all hospitals." Smith was a founder of the Omaha committee.
But Dr. Robert Bonebrake, who now heads the Omaha committee, said local hospitals have similar policies that advise against elective induction before 39 weeks.
"Does it still happen? Yes," Bonebrake, a perinatologist at Methodist Women's Hospital, said. "With the same frequency? Absolutely not."
Bonebrake said that even a hard stop isn't necessarily solid. If a physician really wants to, he can schedule an induction under the pretense that the patient has a medical reason to do so, Bonebrake said.
"I think everybody is doing a much, much better job," he said. "Are we at 100 percent? I would tell you, I don't think so."
Lisa Strasheim, operations director for women and children at Alegent Health, said Alegent has a strict policy that generally doesn't allow elective inductions before 39 weeks.
If a husband were in the military and deploying near the end of the 38th week of pregnancy, that might be an exception, Strasheim said.
In Lincoln, Chambers said a doctor in that situation would have to run it by the hospital's obstetrical department director. "That's the level of commitment that we have," Chambers said.
Bonebrake said hospital policies give doctors an out if they otherwise would be tempted to cave in to a patient's wishes. The doctor can say it can't be done because the hospital won't allow it.
Kourtney Case of Papillion, who is currently at about week 38, recently talked with Dr. Carl Smith at the Nebraska Medical Center about inducing her baby. Case's father will be in town Sept. 2 through Sept. 10.
Case said Smith informed her induction could occur Sept. 7, right at 39 weeks. While Case preferred that it occur naturally, she hoped her father would be there for the birth. She would mull over induction.
"Obviously," she said, "my first priority is the health of my baby."
Contact the writer: