About OHA's 39+ Weeks Hospital Initiative The American College of Obstetricians and Gynecologists, or 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 Statement) 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. OHA is an active particpant with the Ohio Perinatal Quality Collaborative and 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. 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.
Educating Staff and Physicians OHA member hospitals particpating in the program share policies and information with outpatient providers' offices to reinforce information among clinicians and office staff. Particpants are also focusing on: Training coders and birth certificate clerks in documenting accurate neonatal age. The OPQC toolkit provides best practices for this effort. Educating staff on new organizational policies and the importance of eliminating early elective deliveries. Engaging Physicians - Provide education on the detrimental effects of EED to both infant and mother, and provide a simple culturally-sensitive summary of evidence from literature. Best Practices and Referrals Premier Hospital Engagement Network Reducing Non-medically Indicated Early Elective Deliveries Report Centers for Medicare and Medicaid Webinar - Strong Start for Mothers and Newborns - Reducing Early Elective Deliveries American College of Obstetricians and Gynecologists. - Definition of term pregnancy American College of Obstetricians and Gynecologists Nonmedically Indicated Early-Term Deliveries AJOG Article - Reduction in elective delivery at <39 weeks of gestation: comparative effectiveness of 3 approaches to change and the impact on neonatal intensive care admission and stillbirth American Journal of Obstetrics & Gynecology Neonatal and Maternal Outcomes Associated with Elective Term Delivery National Institute for Health Care Management Born Too Early: Improving Maternal & Child Health by Reducing Early Elective Deliveries Ohio Perinatal Quality Collaborative 39 Weeks Project March of Dimes 39+ Weeks Quality Improvement American College of Obstetricians and Gynecologists Elective Delivery Before 39 Weeks FAQ California Maternal Quality Care Collaborative <39 Weeks Toolkit Text4baby
Providing Consumer & Community Education OHA program participants are enlisting childbirth educators to inform women and families during hospital tours or childbrith education classes. They are also enlisting office staff of outpatient providers to provide counseling and print materials to expectant moms, ensuring documentation of informed consent discussions with patients in the medical record, to ensure that women are aware of the risks of early elective delivery, and counseling women contemplating elective induction at or beyond 39 weeks’ gestation with an unfavorable cervix regarding an increased rate of cesarean delivery. Best Practices and Referrals March of Dimes Healthy Babies are Worth the Wait AWHONN Go the Full 40 Handout and Other Resources March of Dimes Healthy Babies are Worth the Wait/Less than 39 Weeks Toolkit OPQC Preterm Birth Resources