“39 Weeks and Beyond”Quality Improvement

Initiative

Megan BranhamDirector of Programs and Public Affairs

South Carolina Chapter

mbranham@marchofdimes.com(803) 403-8522

Our mission and vision

The March of Dimes mission is to improve the health of babies by preventing birth defects, premature birth and infant mortality.

The March of Dimes vision is to become recognized as the foremost champion for babies, renowned as a great organization for volunteer leaders, and certified as a highly effective and efficient philanthropic organization.

March of Dimes and “39 weeks”• Efforts to improve the quality and safety of perinatal care

have received increased focus during recent years and with the 2010 publication of Toward Improving the Outcome of Pregnancy III

• Research has shown that early elective delivery without medical or obstetrical indication is linked to neonatal morbidities with no benefit to the mother or infant.

• In partnership with the California Maternal Quality Care Collaborative (CMQCC) and the California Maternal Child and Adolescent Division within the state Department of Health, created a toolkit entitled Elimination of Non-medically Indicated (Elective) Deliveries Before 39 Weeks Gestational Age.

• This toolkit outlines steps that hospitals can take to begin a quality improvement initiative to eliminate elective deliveries prior to 39 weeks. Download the toolkit from the Prematurity Prevention Resource Center at www.prematurityprevention.org.

What do we mean by 39 weeks? • Elective deliveries (that aren’t caused by a

medical reason), whether induced labor or scheduled C-section, prior to 39 weeks gestation

• Pregnancy dating (knowing for sure when a woman conceived) is tricky, because every woman’s body is different, and the typical “signs” of pregnancy are not always typical for everyone

• The only way to be sure of gestational age of the baby is by an ultrasound in the first trimester of pregnancy. This early ultrasound is not routinely done

• Many women don’t even suspect they’re pregnant until many weeks into their pregnancy

Why?• Much of brain development and other fetal growth

happens in the last weeks of pregnancy.• Many hospitals do not have controls in place to

prevent elective deliveries from being scheduled. Others have controls, but do not enforce them.

• Women often request elective deliveries; physicians often perform them out of convenience for themselves or fear of malpractice if something goes wrong later in the pregnancy.

• The Joint Commission has issued a recommendation to hospitals that they look at their policies regarding elective deliveries prior to 39 weeks and stop doing early deliveries.

2011 Prematurity Report Card

• 2009 preliminary data • 14.5% rate of PTB (<37 weeks)• 10.0% of LPB, 34-36 weeks

gestation (increase from 9.7% in 2010)

Preterm Birth Rates by Gestational Age U. S., 1990, 2000, 2005, 2006, 2007*, 2008*

*provisional Source: National Vital Statistics Reports Vol. 58, Number 16 April 2010.

Percent

Changing Distribution of Singleton Live BirthsUnited States, 1992, 1997, 2002, 2006

The Gestational Age that Women Considered a Baby Full Term

The Gestational Age that Women Consider it Safe to Deliver

Obstet Gynecol 2009;114:1254

Birth Outcomes Initiative• March of Dimes SC Department of Health and Human

Services, SC Hospital Association, SC Department of Health and Environmental Control, Health Insurance , Providers, many more

• Came together in August and meet monthly (goals next slide)

• Create awareness around elective inductions <39 weeks as first action item of group

• Delivering hospitals in SC signed commitment to look at issue and identified 2 champions (OB and Neo) to represent on BOI

• Held press conference in November to create more awareness around this issue

• Professional development held in January for champions and other important point persons

BOI Goals#1. No elective inductions for non-medically indicated

deliveries prior to 39 weeks. This should also help us address reducing the number of c-sections.

#2. Reduce ALOS in NICU/PICU. Data indicates that the Ave. Length of Stay for Medicaid NICU/PICU babies is higher than that of other payors. Admissions to NICU/PICU should also be reduced because of #1.

#3. Target health disparities. African American women accounted for 46.3% of all live births, 57.9% of lbwb, and 64.4% of vlbwb. We will collaborate with DHEC's Office of Minority Health as another partner and ask them to assist in outreach.

#4. Make 17 P available to all pregnant women with no hassle factor and consistent follow up across all payors.

Healthy Babies are Worth the Wait

www.marchofdimes.com/catalog

Healthy Babies are Worth the Wait

Online pledge: Facebook.com/scmarchofdimes

Using social media to educate

Moms-to-be receive quarterly

e-mail newsletters with health information from MOD

Next Steps• Grant funding and partnership with MOD for quality

projects• New PSA and other media messaging for HBWW

How to become involved• Promote HBWW materials and messaging• Participate in BOI• Connect with local MOD offices for partnership

opportunities• More information about HBWW can be found here: marchofdimes.com/professionals/medicalresources_hbww.html