Reducing elective labor induction in San Bernardino County: A public health and hospital maternal health quality improvement partnership

Background: Elective labor induction, especially prior to 39 weeks gestation, appears to increase maternal morbidity and mortality. San Bernardino County experiences both the highest rate of maternal mortality (18.0 per 100,000 live births) and labor induction (18.35% of total births) in California (2006). Countywide, first time mothers face a 1 in 5 chance of being induced; this risk increases to 1 in 4 in low-risk mothers.

Objectives: To reduce pregnancy-related morbidity and mortality by decreasing the rate of elective labor inductions occurring in pregnant women residing in the County to 15%, the ACOG quality benchmark.

Methods: The public health department provided leadership to convene partners from the medical, health education and community arenas to develop common clinical guidelines, a toolkit and data collection methods.

Results: Project accomplishments: • Labor induction toolkit/guidelines developed and distributed to 17 partner hospitals. • Education forum attended by 50 clinicians. Quality improvement data collection from 13 hospitals. • Neighboring health jurisdictions have requested implementation guidelines.

Findings: Many hospitals lack and/or need: • Effective systems to collect and report labor induction data and differentiate elective from non-elective procedures. • Induction policies, guidelines, and procedures for hospitals and physicians. • Improved knowledge of Joint Commission labor induction core measures

Conclusion: Public health departments can lead patient safety initiatives and engage local hospitals to develop policies to improve the quality of maternity care.