Elective early deliveries drop dramatically in study

In a group of diverse hospitals across multiple states, an improvement program substantially and rapidly decreased elective scheduled early-term deliveries to less than 5%.

A study published online by the journal Obstetrics & Gynecology shows that multistate, hospital-based quality improvement programs can be remarkably effective at reducing early elective deliveries of babies.

During the year-long study, the rate of elective early term deliveries (i.e., inductions and cesarean deliveries without medical reason) in a group of 25 participating hospitals fell significantly from 27.8% to 4.8%, a decline of 83%.

The March of Dimes partly funded the study. "This quality improvement program demonstrates that we can create a change in medical culture to prevent unneeded early deliveries and give many more babies a healthy start in life," said Bryan T. Oshiro, MD, lead author of the study, in a March of Dimes press release.

"Reducing unnecessary early deliveries to less than five percent in these hospitals means that more babies stayed in the womb longer, which is so important for their growth and development," said Edward R.B. McCabe, MD, medical director of the March of Dimes. "This project saw a decrease in the proportion of babies born at 37 and 38 weeks and a corresponding increase in the 39-41 week range during the one-year period studied. Additional studies, perhaps over a longer period of time, could clarify whether such quality improvement programs can also bring down a hospital's overall preterm birth rate."

The initiative focused on implementation of a toolkit called "Elimination of Non-medically Indicated (Elective) Deliveries before 39 Weeks Gestational Age," to guide changes in early term delivery practices. The toolkit can be downloaded free from the Prematurity Prevention Resource Center at prematurityprevention.org.

This was the first project of a collaborative with perinatal quality improvement advocates from state health departments, academic health centers, public and private hospitals, and March of Dimes chapters from the five most populous states in the country: California, Texas, New York, Florida, and Illinois. These 5 states account for an estimated 38% of all births in the United States, according to the March of Dimes.