Hospitals’ Move to Reduce Number of Early Elective Deliveries Yields Results

Andrew Kitchenman | March 5, 2014 | Health Care
State average drops by nearly three-quarters in three years, Leapfrog Group reports

Only those hospitals providing information to The Leapfrog Group. Search or zoom to isolate a hospital.

The days of expectant mothers and their doctors arranging early deliveries to suit their schedules appear to be coming to an end, thanks to hospitals taking an aggressive stand on the issue.

The average percentage of births at New Jersey hospitals that were early elective deliveries has fallen for three straight years, dropping from 15.7 percent in 2010 to 11.7 percent in 2011, 7.2 percent in 2012, and decreasing by another 4 percent last year, according to a new report from the Leapfrog Group.

Early elective deliveries — which generally occur in the 38th or 39th week of pregnancy — have been associated with increased risk of respiratory problems for infants, according to the American Congress of Obstetricians and Gynecologists.

“There’s an increased health risk for every week early that a baby is born,” said Laurie Navin, program services director for the March of Dimes’ New Jersey chapter.

Of the 47 hospitals that reported results to the Leapfrog Group, 36 have either reduced the rate of early elective deliveries to less than 5 percent or made progress over the past year toward that goal.

Hospitals across the state have instituted a “hard-stop” policy, in which these deliveries can only be scheduled if the doctor justifies the decision to the hospital’s medical leaders.

Navin said the groundwork for the reduction was laid in 2008, when the March of Dimes released a preterm birth report card that drew the attention of hospital leaders and state health officials. Navin singled out Virtua President and CEO Richard P. Miller for challenging hospitals to work to reduce early elective deliveries. This led to the New Jersey Perinatal Collaborative, a group of hospitals that agreed to lower the number of early elective deliveries.

“If it’s at all possible, if a woman is healthy and the baby is healthy we encourage women to wait” until at least 39 weeks of pregnancy have been completed, Navin said.

The number of cesarean-section births has been rising over the past 30 years, an indication that early elective deliveries also increased, although they make up only some of the C-section births.

Navin said many women and doctors have scheduled early deliveries without knowing that there could be risks.

“I don’t think anybody did anything maliciously or consciously,” but women and doctors wanted to schedule births for various reasons, ranging from the availability of the doctors to the ability to schedule visits from out-of-state family members to assist the mothers, Navin said.

Dr. Sharon Mass, state chairwoman of the American Congress of Obstetricians and Gynecologists (ACOG), noted that her organization has long recommended scheduling deliveries after 39 weeks. However, pregnancies in the 38th and 39th weeks also were considered full-term, leading some doctors and patients to schedule deliveries then.

“Change is always hard and it’s an evolution. There were some who were more resistant than others, because it was a habit,” Mass said. She noted that when the American Board of Internal Medicine Foundation asked each medical specialty to list “five things physicians and patients should question” as part of its Choosing Wisely Initiative, ACOG listed early elective deliveries first..

“That’s a really well-received program and I think another source contributing to people complying with this recommendation,” Mass said.

New Jersey Hospital Association President and CEO Betsy Ryan noted hospitals have been working on the issue for several years, as part of the perinatal collaborative. This led to a statewide challenge to bar early elective deliveries in 2012.

“The results reflected here are very satisfying, not just because they show that our commitment and attention to this issue are yielding results, but also because it’s leading us to a generation of healthier moms and babies,” Ryan said in a statement.

The Leapfrog Group, a Washington, D.C.-based nonprofit founded by employers and focused on increasing hospital safety, quality, and affordability, released the report on Monday.

Leapfrog Group spokeswoman Erica Mobley said the organization’s reports have helped lead to declines in early elective deliveries across the country by shining a light on the practice.

“When we began publicly reporting, it really started to galvanize a whole wave of change, and then many other hospitals got on board,” Mobley said.