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 vaginal or C-section, unless otherwise medically indicated. (ACOG Committee Statement – Reaffirmed 2021)

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 was an active participant 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. 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.

OHA member hospitals participating in the program share policies and information with outpatient providers’ offices to reinforce information among clinicians and office staff. Participants also focus on:

• 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 infant and mother, and provide a simple culturally-sensitive summary of evidence from literature.

Best Practices

• 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
• CMS & March of Dimes – Strong Start for Mothers and Newborns Initiative
• California Maternal Quality Care Collaborative – Early Elective Deliveries Toolkit

Providing Consumer & Community Education

OHA program participants are engaging childbirth educators and outpatient office staff to inform expectant mothers about the risks of early elective delivery. This includes counseling, providing print materials and documenting informed consent discussions. Special attention is given to women considering elective induction at or beyond 39 weeks with an unfavorable cervix due to the increased cesarean delivery rate.

Best Practices and Referrals

• March of Dimes Healthy Babies are Worth the Wait
• AWHONN Go the Full 40 Handout and Other Resources