Quality Quest is on a mission to eliminate early deliveries that are done for convenience.

Evidence shows babies require at least 39 weeks to develop fully. Yet 18 percent of deliveries nationally occurred too early. In Illinois, the average jumps to 23 percent (Leapfrog Group). Advances in caring for premature babies and widely available neonatal intensive care treatment have lulled doctors and parents into believing that babies born a few weeks before they are due will do just fine.

That turns out to be wrong. Babies born even a few days before 39 weeks are sicker and have poorer outcomes. A parallel from history suggests we take these risks seriously and adjust practice patterns that have gradually shifted from letting mother nature take her course to using strong medicines to bring on labor when it is most convenient. .

Savior of Mothers

The story of Hungarian physician Ignaz Philipp Semmelweis (1818 – 1865) has come to personify the struggle of advancing evidence on a medical community set in its ways.

Semmelweis has been nicknamed "Savior of Mothers" for his work in dramatically reducing the incidence of puerperal fever at Vienna General Hospital in the late 19th century. Also called childbed fever, puerperal fever plagues women shortly after giving birth.

Vienna General Hospital housed two obstetrical clinics, one run by doctors and the second by midwives. Death rates from puerperal fever spiked and dipped erratically in the first clinic, with a baseline of about 10 percent.

In the other ward, the rate averaged less than 4 percent. The discrepancies did not escape the expecting mothers, who often begged to be admitted to the second clinic. The high mortality rate of his clinic deeply troubled Semmelweis.

In 1847, a physician died after a student accidentally cut him with a scalpel during a postmortem examination. When the autopsy showed pathology similar to that of the victims of puerperal fever, Semmelweis concluded the doctor had been contaminated by the corpse.

Semmelweis proposed the first clinic medical staff examined their patients while carrying "cadaverous particles" on their hands. The midwives of the second clinic did not have contact with cadavers.

Semmelweis responded by instituting a more rigorous cleanliness policy. Doctors were ordered to wash their hands with chlorinated lime solutions, a bleaching agent. Death rates in the first clinic immediately dropped from 10 percent to about one to two percent.

Invisible killer particles transferred through corpses? These groundbreaking findings sharply challenged existing beliefs. Disease was thought to be caused by an imbalance unique to each patient, often treated with bloodletting.

Priding themselves on superior empirical thought, Semmelweis' colleagues immediately rejected the idea that uncleanliness could be the sole, consistent cause of childbed fever. They accused Semmelweis of lacking proper scientific reasoning. They passionately dismissed his claims that doctors could be responsible for infecting the patients they intended to cure.

As papers dismissing his assertions received awards, Semmelweis grew increasingly angry at the medical establishment. He lashed out with angry letters. He became obsessed with childbed fever. The situation led him to severe episodes of depression and neurosis.

He was confined to a mental institution, where he was greeted with a severe beating from the guards. Wearing a strait jacket, he was left in a dark room to fade. He died within two weeks from infection of his wounds.

The Semmelweis Reflex

Vindication would come two decades later with Louis Pasteur and the germ theory of diseases, which states microorganisms can cause disease. Semmelweis' legacy is as a celebrated pioneer in antiseptic policy.

Philosophy students studying the significance of scientific knowledge learn Semmelweis' story and about the Semmelweis Reflex. The Semmelweis Reflex refers to the knee-jerk rejection of evidence that contradicts current thinking or procedure.

The Semmelweis Reflex is in play in regard to elective pre-term inductions and C-sections. Doctors may see, or chose to see, no harm in the principles they've always followed. Yet, the evidence is clear. Important development takes place in the last few weeks of pregnancy. The medical community must react to evidence-based medicine and commit to eliminating elective pre-term deliveries.

Let us learn from the mistakes of history so the future does not have to learn from ours.