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Elective Deliveries Before 39+ Weeks

Father_4A_iStock-598072770.jpgAs part of OHA's comprehensive and targeted plan to reduce Ohio's infant mortality rate, hospitals are working to reduce Ohio's high rate of early elective delivery. Scheduled delivery prior to 39 completed weeks gestation, also known as early elective delivery (EED), is defined as scheduled vaginal delivery or cesarean section (C-section) between 37 and 39 completed weeks of gestation. The American College of Obstetricians and Gynecologists (ACOG) promotes a standard of waiting at least 39 completed weeks gestation prior to scheduling a delivery for both vaginal or C-section, unless otherwise medically indicated. (ACOG Committee Opinion - Reaffirmed 2017)

Compared to spontaneous labor (labor that is not induced), scheduled inductions result in more C-sections and longer hospital stays for moms. Repeat scheduled C-sections before 39 weeks gestation also result in higher rates of adverse respiratory outcomes, mechanical ventilation, sepsis, and hypoglycemia (low blood sugar) for the newborn.
 

About the 39+ Weeks Hospital Initiative

39-weeks_purple.jpgThe Ohio Perinatal Quality Collaborative (OPQC) has been working to reduce EED in Ohio since 2007. Starting with Ohio's largest maternity and pediatric hospitals, this public and private collaboration has made dramatic improvements in this measure and has expanded this effort to all maternity hospitals in 2014 (learn more here).

It is clear that while significant progress has been made, opportunity for continued improvement exists. Continuing to reduce the rate of EEDs is one of OHA's priority areas of focus in an effort to reduce Ohio's infant mortality rate. This hospital-led initiative focuses on adopting scheduling practices that align with eliminating EEDs; promoting physician accountability, transparency and discussion; and providing patient and community education. For more information about this initiative, see OHA's 2014 White Paper on Reducing Early Elective Deliveries.

Standardize the Process

Evaluate Scheduling Process

Consider integrating a "Hard Stop" for scheduled deliveries prior to 39 weeks gestation.

Educate Staff & Physicians

Educate Staff

Share policies and information with outpatient providers' offices to reinforce information among clinicians and office staff. 

Provide Consumer & Community Education

Inform the Consumer

  • Education-Logo.JPGEnlist childbirth educators to inform women and families, during hospital tours or childbirth education classes.
  • Enlist office staff of outpatient providers to provide counseling and print materials to expectant moms. Elective delivery before 39 weeks gestation is associated with significant maternal and neonatal morbidity. It is essential to educate consumers and patients about the risks associated with EED. Below are several resources for use in educating patients – and their family and friends – about why it's best to wait at least 39 weeks.
  • Ensure documentation of informed consent discussions with patients in the medical record, to ensure that women are aware of the risks of early elective delivery.
  • Counsel women contemplating elective induction at or beyond 39 weeks’ gestation with an unfavorable cervix regarding an increased rate of cesarean delivery.

OHA's Infant Mortality Initiatives:
Breastfeeding
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Safe Infant Sleep

 
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