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39 Weeks - Early Elective Deliveries

As 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 deliveries, or EEDs. Scheduled delivery prior to 39 completed weeks gestation, also known as early elective delivery, is defined as scheduled vaginal delivery or cesarean section (C-section) between 37 and 39 completed weeks of gestation. 

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

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