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Most hospitals have early elective delivery policies


Nearly two-thirds of all U.S. hospitals that handle non-emergency births have instituted policies to eliminate non-medically indicated deliveries prior to 39 weeks’ gestation, according to a study.

Over the last several years, an increasing number of deliveries have occurred prior to 39 weeks’ gestation, according to background information in the study, which was presented May 6 in New Orleans at the annual clinical meeting of the American College of Obstetricians and Gynecologists.

However, recent research has shown multiple health risks associated with delivering babies before 39 weeks, including neonatal respiratory distress and admission to the NICU. In an effort to reverse the practice, there has been a nationwide movement, including many statewide initiatives, to increase awareness about the harm that non-medically indicated deliveries can cause.

Nathaniel G. DeNicola, MD, and colleagues at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia contacted all 2,641 US hospitals with a registered labor and delivery unit. The hospitals were asked whether they had a policy regarding non-medically indicated deliveries.

Of the 2,367 hospitals that responded, 66.5% reported having a formal policy in place against the practice, with 33.5% reporting no policy. Of the hospitals without a formal policy, 53% said NMI deliveries were against their standard of care. Of the hospitals with a formal policy, 69% said they had a “hard-stop” policy, meaning a strictly enforced hospital policy against NMI deliveries at fewer than 39 weeks.

The survey of hospitals also showed that the state initiatives appear to be effectively communicating their message. DeNicola found significantly more hospitals with formal policies in states with quality collaboratives than in states without such collaboratives. Quality collaboratives are regional hospital or community alliances working together to promote high-value, cost-saving medical care.

“We had a number of hospitals volunteer that they were following the state initiative,” DeNicola said in a news release. “In 18 states, quality collaboratives had reached such high awareness that the charge nurses we called randomly not only knew about the state collaboratives, but felt compelled to tell us that their hospitals had been responsive to the collaboratives’ efforts to get them to implement a policy.

“Hospital policies have been shown to be one effective tool in reducing the incidence of non-medically indicated deliveries. There is reason to be encouraged that hospital policies are decreasing the frequency of this practice, and we expect that fewer elective deliveries prior to 39 weeks means fewer term babies going to the NICU.”


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