During the last few weeks of pregnancy, critical fetal development is still occurring. Yet some mothers request that their baby be born sooner than their due date. These are early elective deliveries: inductions or cesarean sections performed prior to 39 completed weeks gestation without medical necessity.
These procedures carry significant health risks to both mom and baby, and can also result in NICU admissions, increased length of stay, and higher costs to patients and payers. The American College of Obstetricians and Gynecologists (ACOG) has advised against these deliveries for over 30 years.
Groundbreaking Public Reporting
In 2010, The Leapfrog Group first publicly reported rates of early elective deliveries by hospital. That year, the national average rate was 17%—a shocking figure. But that public reporting accelerated longstanding efforts by a network of organizations working to eliminate unnecessary deliveries, including the Catalyst for Payment Reform, the National Business Group on Health and the March of Dimes. At the Centers for Medicare & Medicaid Services, both the Partnership for Patients Program and the Strong Start for Mothers and Newborns Initiative identified early elective deliveries as a top priority issue early in 2012, and have both aligned their resources to achieving these results.
Five years later, we have seen tremendous progress. From 2010 to 2015, the national rate plummeted to just 2.8% - well below the standard set by Leapfrog of 5%.
“This is one of the most extraordinary examples of progress in health care that I’ve seen in my career. It shows that public reporting can galvanize change, and that saves lives.” - Leah Binder, president and CEO.
States Put the Pressure On
The vast majority of states are now reporting early elective delivery average rates of less than 10 percent. Dramatic improvements from states like South Carolina were precipitated by payment reform penalties enacted by government and private sector stakeholders to discourage the practice of early elective deliveries. In other states, local coalitions were instrumental in leading the charge. In Illinois, the Midwest Business Group on Health spearheaded their own "Preventing Early Elective Deliveries" project, which effectively reduced the state rate from 22% in 2010 to 2% in 2015.
But despite nationwide and statewide successes, widespread variation still exists. Some hospitals are still reporting early elective delivery rates higher than 20 and 30 percent, which means there is still work to be done.
To learn more about the last few weeks of pregnancy and to get a list of questions you may want to ask your health care provider at your next prenatal care checkup, visit Childbirth Connection or the March of Dimes.
Reducing Early Elective Deliveries
"How do institutions change their practices? In medicine, the usual answer is “slowly.” Clinical trials can show the efficacy of a new practice — yet, decades later, many physicians still haven’t gotten the message. Until four years ago, it seemed like early elective delivery was a textbook example of evidence widely ignored. These are induced or cesarean section deliveries after 37 completed weeks but before 39 completed weeks of gestation, when not medically necessary..." Read more >
Rate of babies delivered early at U.S. hospitals drops sharply
"U.S. hospitals are making major strides at clamping down on early deliveries of babies and instead letting Mother Nature take its course in response to growing pressure from employers, government officials and patient-safety advocates. The Leapfrog Group, an employer-backed organization that tracks hospital safety and quality, published data Monday showing a sharp decrease in early-elective deliveries since 2010 nationwide and in California..." Read more >