The employer-driven hospital quality watchdog, The Leapfrog Group, issued a Call to Action in response to its new data finding that thousands of babies are electively scheduled for delivery too early, resulting in a higher likelihood of death, being admitted to a Neonatal Intensive Care Unit (NICU), and life-long health problems.
Despite the importance of this issue to women and babies, Leapfrog is the first national organization to make this information public by hospital. The findings from 773 hospitals in Leapfrog's 2010 annual hospital survey reveal significant variation among hospitals in their rates of early elective cesarean section and elective inductions, with some hospitals having ten times the rate of others.
"Hospitals, health plans, providers, and communities need to do more to protect women and babies from this harmful practice," said Leapfrog CEO Leah Binder. "And women need to protect themselves by refusing to schedule their deliveries before 39 weeks without a sound medical reason, and by knowing the facts about the hospitals they plan to deliver in." She noted that currently only hospitals that report to Leapfrog's annual hospital survey are making their rates of early elective deliveries public. "Every hospital should publicly report on their rate and actively prevent the practice, and every woman planning to give birth should demand the information," Binder added.
Experts, including those from the American College of Obstetricians and Gynecologists (ACOG), Childbirth Connection, and the March of Dimes, caution that the amount of time a baby needs to develop fully, which includes having a fully developed brain and other organs, is at least 39 completed weeks. Sometimes there is a medical reason to schedule a newborn delivery before the 39th week; for example, if mother has high blood pressure at the end of pregnancy or broken membranes before labor begins. However, Leapfrog finds that newborns are being "electively" scheduled for delivery before the 39th week, meaning without a medical reason, at alarming rates.
Leapfrog, Childbirth Connection, and the March of Dimes are working together to share information about the importance of every week of pregnancy with women, purchasers, and others. In addition, Binder announced a Call to Action to other leaders in the health care community to prevent elective deliveries before 39 weeks. Responding to that Call to Action is a partnership of some of the nation's largest health plans: Aetna, CIGNA, UnitedHealthcare, and WellPoint. These four national health plans have been collaborating on an awareness campaign that includes three key messages: the last weeks of pregnancy are important; there are risks for mothers and babies if births are scheduled before 39 weeks for nonmedical reasons; and expectant mothers should investigate the rates of elective deliveries for hospitals in their community. Leapfrog's membership of employers and regional business coalitions will also help raise awareness in their local communities by sharing Leapfrog data and resources from Childbirth Connection and the March of Dimes with their employee populations.
Also, as part of the Call to Action, Leapfrog will host two national webinars for health care professionals. The webinars, hosted by Leapfrog's Senior Science Director Dr. Barbara Rudolph and March of Dimes Medical Director Dr. Alan Fleischman, will focus on the new 39-week toolkit developed by the March of Dimes and its partners. These webinars are being offered free of charge on February 15th from 12 noon to 1:00 p.m. ET and February 17th from 3:00 p.m. to 4:00 p.m. ET to accommodate both east and west coast health care professionals.
These new data on early elective deliveries come from Leapfrog's 2010 annual hospital survey, where hospitals are asked to report the percentage of non-medically indicated births between 37 and 39 weeks gestation that were delivered electively by cesarean section or induction. The Joint Commission has begun monitoring hospital performance on this quality measure as well. In April 2010, they added the elective deliveries measure to their perinatal core measure set.
The survey measure is endorsed by the National Quality Forum, an organization tasked with bringing together experts and stakeholders to come to consensus on national measures of hospital quality and safety. Hospital rates of elective deliveries scheduled too early are now available for easier viewing on a special website: www.leapfroggroup.org/tooearlydeliveries.
"The last few weeks of pregnancy are critical to a baby's health because important organs, including the brain and lungs, are not completely developed until then," said Alan R. Fleischman, MD, senior vice president and medical director of the March of Dimes. "We thank Leapfrog for making this data available. A baby's birth should not be scheduled before 39 weeks of pregnancy, unless their health care provider says it's medically necessary. The 39-week toolkit can help ensure that inductions and c-sections are done at the right time and for the right reasons."
Maureen Corry, executive director for Childbirth Connection, a national advocacy organization that works to improve the quality of maternity care, salutes Leapfrog for making hospital rates of elective delivery accessible so women can make an informed decision about where to give birth. "Now we need to make the data available for all hospitals and individual physicians and midwives. We are pleased to join Leapfrog's Call to Action by providing women with evidence-based resources on benefits, harms, and appropriate use of labor induction, including tips and tools for avoiding an unnecessary induction."
According to Leapfrog, hospital rates of early elective deliveries range from less than 5% to more than 40%. The 773 hospitals from around the country that voluntarily provided Leapfrog with information on this measure reported over 57,000 early elective deliveries by cesarean section or induction during the reporting period. The variation in hospital rates has long been talked about in the health care community, but Leapfrog's release of 2010 data is the first real evidence that the practice of scheduling newborn deliveries before 39 weeks without a medical reason is common and varied among hospitals even in the same state or community. For example, in the city of Los Angeles, hospitals reported rates as low as 4% and as high as 29%. In Boston, Leapfrog saw similar variation with some hospitals reporting near 0 and others as high as 27%.
In 2010, Leapfrog's target for hospitals was a cesarean section and/or induction rate of less than 12% of the total number of non-medically indicated deliveries occurring between the 37th and 39th week of gestation. In 2011, Leapfrog will lower the target to 5%. This change was made in part because 50% of reporting hospitals were able to meet Leapfrog's 12% target in 2010 and 29% of reporting hospitals exceeded Leapfrog's target by reporting rates of 5% or less. Additionally, Leapfrog has identified several hospitals and health systems, such as Hospital Corporation of America, which have promoted and supported implementation of policies to deter doctors from scheduling cesarean sections and elective inductions for nonmedical reasons. This example suggests that hospitals can help implement policies that improve adherence to evidence-based care.