Report Shows Elective Deliveries are Falling

A study published today in Obstetrics & Gynecology shows that multistate, hospital-based quality improvement programs, including the one at St. Joseph’s Women’s Hospital, can be remarkably effective at reducing early elective deliveries of babies.

The rate of elective early term deliveries (i.e., inductions of labor and Cesarean sections without a medical reason) in a group of 25 participating hospitals fell significantly from 27.8 percent to 4.8 percent during the one-year project period, an 83 percent decline.

At St. Joseph’s Women’s Hospital, the Perinatal Safety Committee established scheduled delivery guidelines and their rate fell from 38.6 percent to 3.3 percent during 2011.

The March of Dimes, which partly funded the initiative, says this is good news because babies delivered before full-term are at increased risk of serious health problems and death in their first year of life.

“This quality improvement program demonstrates that we can create a change in medical culture to prevent unneeded early deliveries and give many more babies a healthy start in life,” says Bryan T. Oshiro, MD, of Loma Linda University School of Medicine and lead author of the study.

“Reducing unnecessary early deliveries to 3 percent means that more babies stayed in the womb longer, which is so important for their growth and development,” says Karen Howell, Director of Patient Care Services at St. Joseph’s Women’s Hospital. “Overall, this project saw a decrease in the proportion of babies born at 37 and 38 weeks and a corresponding increase in the 39-41 week range during the one-year period studied.”

St. Joseph’s Women’s Hospital Perinatal Safety Committee identified two physician leads on the March of Dimes project. Dr. Jeffrey Angel, Medical Director of Maternal Fetal Medicine, and Dr. Richard Matthews, of Lifetime Obstetrics and Gynecology, were the ‘hard stops’, which meant that any requests for a scheduled delivery outside of the guidelines had to go to them for review. Written guidelines and the involvement of these physicians were crucial to this culture change. Throughout 2012, the rate has decreased further to less than 1 percent.

St. Joseph’s Women’s Hospital, part of BayCare Health System, implemented a toolkit called “Elimination of Non-medically Indicated (Elective) Deliveries before 39 Weeks Gestational Age” to guide changes in early term delivery practices. The toolkit was developed in partnership with the March of Dimes, the California Maternal Quality Care Collaborative and the California Maternal Child and Adolescent Division within the California Department of Public Health. It can be downloaded free from the Prematurity Prevention Resource Center atprematurityprevention.org.

St. Joseph’s Women’s Hospital is one of the first hospitals in the nation to participate in a collaborative of perinatal quality improvement advocates with state health departments, academic health centers, and March of Dimes chapters from the five most populous states in the country: California, Florida, Illinois, New York, and Texas. These five states account for an estimated 38 percent of all births in the United States.

The March of Dimes urges hospitals, health care providers, and patients to follow American College of Obstetricians and Gynecologists guidelines that if a pregnancy is healthy, to wait for labor to begin on its own. The final weeks of pregnancy are crucial to a baby’s health because many vital organs, including the brain and lungs, are still developing.

“A Multistate Quality Improvement Program to Decrease Elective Deliveries Before 39 Weeks,” by Dr. Oshiro and others, appears in the April 8 online edition of Obstetrics &Gynecology, Vol 121, No. 5, May 2013.