272515 Elimination of Non-medically Indicated (Elective) Deliveries Before 39 Weeks Gestational Age: An overview of a multi-hospital initiative

Monday, October 29, 2012 : 8:30 AM - 8:50 AM

Leslie Kowalewski, BS , March of Dimes, California Chapter, San Francisco, CA
Although the American College of Obstetricians and Gynecologists issued guidelines recommending against non-medically (elective) deliveries prior to 39 weeks gestation, elective preterm deliveries had been increasing reflecting the rising rates of labor induction and cesarean delivery. Research has shown that early elective delivery without medical or obstetrical indication is linked to neonatal morbidities with no benefit to the mother or infant. To improve the quality and safety of perinatal care, the March of Dimes, the California Maternal Quality Care Collaborative, and the California Department of Public Health, Maternal, Child, and Adolescent Health Division collaborated to develop and disseminate a toolkit, entitled “Elimination of Non-medically Indicated (elective) Deliveries Before 39 Weeks Gestational Age.” Beginning in 2010, 25 hospitals from the Big Five States – CA, FL, IL, NY and TX –met to put into place the key change components necessary to eliminate elective deliveries. Hospital policy was rewritten, scheduling guidelines outlining medically and non-medically indicated deliveries were adopted, and medical leadership was appointed who could question scheduled deliveries less than 39 weeks gestational age without clear indications. In January 2011 the Big Five Hospital Network kicked off the initiative. Active data entry began on all scheduled deliveries to understand the progress in eliminating elective deliveries. Monthly conference calls were organized to discuss challenges, barriers and success. Trend data were shared monthly to support hospitals in driving and sustaining results. The success and lessons learned by the Big Five Hospital Network through the pilot have been utilized by hospitals across the Country.

Learning Areas:
Clinical medicine applied in public health
Program planning
Public health administration or related administration

Learning Objectives:
- Describe how to implement the toolkit, entitled Elimination of Non-medically indicated (Elective) Deliveries Before 39 Weeks Gestational Age - Describe the key resources available to support implementation of the initiative to eliminate non-medically indicated deliveries before 39 weeks gestation age

Keywords: Maternal and Child Health, Birth Outcomes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Serves as Associate Director, March of Dimes California Chapter and Director, Big 5 State Prematurity Initiatives. With over 15 years with the March of Dimes, she represents the March of Dimes with the California Maternal Quality Care Collaborative where she serves on the Executive Committee, Less Than 39 Week Toolkit Development Task Force, and Maternal Data Center Steering Committee. She earned a bachelor of science degree in health promotion and education from Oregon State University.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.