U.S. labor induction rates have more than doubled in a sixteen year period and state caesarean rates increased to one in three births from one in five in a twelve year period, according to a National Vital Statistics Report and The Massachusetts Department of Public Health. These increases have corresponded with a significant fall in the mean birth weights of newborns. Studies suggest that patient and physician convenience, coupled with the fee-for-service payment model, where caesarean (c-sections) cost an average of $3,500 more than vaginal deliveries, are likely drivers of these alarming trends.

Both mother and child have increased risks from early birth inductions and caesareans. Women who are induced in the 37 th to 38 th week of pregnancy have a significantly higher risk of a c-section, and once mothers have had a c-section, they are more likely to have one in the future, adding to their risk. Postpartum complications from c-sections include hematoma (a tissue blood mass), wound opening, anemia, endometriosis, urinary tract infection, and sepsis, according to The American Journal of Obstetrics & Gynecology. Babies whose mothers are induced before the baby is 39 weeks have a higher likelihood of death, being admitted to a Neonatal Intensive Care Unit (NICU), feeding disorders, and life-long health problems, according to the journal.

You can protect yourself and your baby by not scheduling a delivery before 39 weeks without a sound medical reason and researching hospitals' early induction rates. Reasons to have an early induction include pre-labor rupture of membranes at 37-42 weeks (broken water), pregnancy that has lasted more than 41 weeks, and mild high blood pressure at full term. Common reasons for induction that are not supported by research include a "too big baby" and "too small baby," according to Childbirth Connection, a national not-for-profit organization devoted to improving the quality of maternity care.

The Leapfrog Group, a coalition of public and private purchasers of health benefits, including the GIC, recently added hospitals' performance on deliveries scheduled too early to its online Hospital Survey of patient safety measures. The Leapfrog Group's target for a cesarean section and/or induction rate is less than 12% of the total number of non-medically indicated deliveries occurring between the 37 th and 39 th week of gestation. This target number will be lowered to 5% for 2011. There is a wide disparity in these rates for Massachusetts hospitals ranging from 0% to over 40%. Hospitals that have excellent results include Beth Israel Deaconess Medical Center in Boston; Cambridge Health Alliance, Cambridge; Caritas Good Samaritan Medical Center in Brockton; Fairview Hospital in Great Barrington; Falmouth Hospital; Metrowest Medical Center; Morton Hospital in Taunton; Signature Healthcare Brockton Hospital; and Winchester Hospital. See the Too Early Deliveries section of Leapfrog's website for hospital ratings and other links and resources for information on this important topic.

This information provided by the Group Insurance Commission .