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News & Updates

Quality Improvement Program Results in Fewer Unnecessary Early Deliveries

News | May 30, 2013

A study published in Obstetrics & Gynecology shows that multi-state, hospital-based quality improvement programs, including the one at ECRMC, can be remarkably effective at reducing early elective deliveries of babies.
The rate of elective early term deliveries (i.e., inductions of labor and Cesarean sections without a medical reason) in a group of 25 participating hospitals fell significantly from 27.8 percent to 4.8 percent during the one-year project period, an 83 percent decline.
ECRMC was one of only five (5) hospitals (Big 5) chosen initially to make the changes in the program in 2010. An effort to make changes was put into place as a result of recent studies showing major changes occurring in brain development during the last weeks of pregnancy.
The success of the campaign as it evolved has been clear locally, with the numbers of early term deliveries dropping significantly between 2010, when protocol was adopted at the Big 5, and 2012. In 2010, the elective early term delivery rate was at 28% (344 of 1226 deliveries). In 2011, the number dropped to 5.6% (69 of 1227 deliveries). In 2012, that number dropped even further to 2.6% (29 of 1143 deliveries).
The March of Dimes, which partly funded the initiative, says this is good news because babies delivered before full-term are at increased risk of serious health problems and death in their first year of life.
“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,” says Bryan T. Oshiro, MD, of Loma Linda University School of Medicine and lead author of the study. 
“A reduction of unnecessary early deliveries to 2.6% means that more babies stayed in the womb longer, which is so important for their growth and development,” says Ron Olds, chief nursing officer, ECRMC. “Overall, 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.”
During the 2010 – 2012 period ECRMC saw a corresponding decrease of babies admitted to NICU or Intermediate Care Nursery (ICN). This is an important stat for the hospital as any admission to the NICU or ICN can cause issues as babies are separated from their mothers at a critical time. It can also mean newborns will have an increase in the length of stay, burdening a new mother healing from the birth process or with other children to care for.
ECRMC implemented 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 was developed in partnership with the March of Dimes, the California Maternal Quality Care Collaborative and the California Maternal Child and Adolescent Division within the California Department of Public Health. It can be downloaded free from the Prematurity Prevention Resource Center at
ECRMC is one of the first hospitals in the nation to participate in a collaborative of perinatal quality improvement advocates with state health departments, academic health centers, and March of Dimes chapters from the five most populous states in the country: California, Texas, New York, Florida and Illinois. These five states account for an estimated 38 percent of all births in the United States. 
The March of Dimes urges hospitals, health care providers, and patients to follow American College of Obstetricians and Gynecologists guidelines that if a pregnancy is healthy, to wait for labor to begin on its own.  The final weeks of pregnancy are crucial to a baby’s health because many vital organs, including the brain and lungs, are still developing. 
 “A Multistate Quality Improvement Program to Decrease Elective Deliveries Before 39 Weeks,” by Dr. Oshiro and others, appears in the April 8 online edition of Obstetrics & Gynecology.