The last few weeks of pregnancy are critical to a baby's health because important organs, including the brain and lungs, are not completely developed until the end of pregnancy. A baby's birth should not be scheduled before 39 weeks of pregnancy, unless medically necessary. The Leapfrog Group, a coalition of public and private healthcare purchasers, reports that hospital rates of early elective deliveries range from less than 5% to more than 40%. The 773 hospitals from around the country that voluntarily provided Leapfrog with information on this measure reported over 57,000 early elective deliveries by cesarean section or induction during the reporting period. The variation in hospital rates has long been talked about in the health care community, but Leapfrog's release of 2010 data is the first real evidence that the practice of scheduling newborn deliveries before 39 weeks without a medical reason is common and varied among hospitals even in the same state or community.
Elimination of early elective deliveries requires effort on behalf of physicians, nurses and hospital leaders. Successful implementation of a 39 week induction program can only come from a commitment to providing care that is patient-centered and safe.
The MPQC is a cooperative voluntary program involving Massachusetts maternity facilities and key perinatal stakeholders, designed to promote the sharing of best practices of care. The collaborative is comprised of representatives from the 46 birthing hospitals in the state including, but not limited to Chairs of Obstetrics, Clinical Nurse Mangers, Quality Improvement professionals, and other clinical staff; Representatives from the Massachusetts Department of Health, including Office of Data Translation and Medical Director; Insurers and other stakeholders. The March of Dimes provides administrative support, direction, and financial support to the collaborative. As of September 2014 the MPQC is one of six Perinatal Quality Collaboratives that was awarded the CDC State Based Perinatal Quality Collaborative grant awards. The MPQC hosts semi-annual summits and collaborative calls between summits.
These recommendations represent a core set of clinical guidelines for average-risk patients from the general population. The guidelines should not supplant clinical judgment or the needs of individual patients. These guidelines are intended as quality-practice recommendations and are not intended as a description of benefits, conditions of payment, or any other legal requirements of any particular health plan or payer. Each health plan or payer makes its own determination of coverage and benefits. In the event that these practice recommendations are inconsistent with any applicable laws or regulations, such laws or regulations take precedence.
Early Elective Delivery (EED)
Approximately 4 million births occur in the United States yearly (Martin et al., 2015). An early elective delivery is a delivery performed for a nonmedical reason prior to 39 weeks of gestational age (ACOG, 2013). In the U.S., approximately 10-15 percent of all births are performed early without a medical reason (Clark et al., 2009). Additionally, nearly 9 percent of U.S. births that are paid for by Medicaid are early elective deliveries (Flowler et al., 2014). A survey of insured women found that 92.4 percent of women reported that giving birth before 39 weeks was safe (Goldenbery et al., 2009). Infants delivered prior to 39 weeks without medical reason are at an increased risk of lower brain mass (March of Dimes, 2012), low birth weight (Donahue et al., 2010), feeding problems (Wang et al., 2004), respiratory distress syndrome (Hibbard et al., 2010) and longer hospital stays (Kowlessar, Jiang, & Steiner, 2013).