HBWW quality improvement and hospital recognition programs

Research shows that choosing to deliver a baby before 39 weeks when there are no medical indications for delivery puts infants at a higher risk of neonatal death and of health problems such as respiratory distress syndrome, need for ventilator support and persistent pulmonary hypertension, resulting in increased NICU admissions.1,2 The March of Dimes works with doctors and nurses, hospitals, hospital associations, insurers, regional collaboratives, patients and their families to reduce elective deliveries before 39 weeks gestation.3

In 2014, the March of Dimes supported 100 hospitals across 28 states to implement the March of Dimes 39+ Weeks Quality Improvement Service Package. The Service Package complemented the information in the Elimination of Non-medically Indicated (Elective) Deliveries Before 39 Weeks Gestational Age toolkit and included action-oriented guidance, data collection tools and other support services to assist hospitals in implementing a successful perinatal quality improvement initiative to eliminate elective deliveries prior to 39 weeks. 

The Elimination of Non-medically Indicated (Elective) Deliveries Before 39 Weeks Gestational Age toolkit is available to hospitals across the country and can be downloaded for free at prematurityprevention.org.
The 100 hospital teams participating in this initiative had access to a secure March of Dimes data portal, which included webinars focused on implementation guidance, a project blog and data-reporting tools. Hospitals also had access to perinatal and quality improvement experts via a monthly call and an in-person Grand Rounds. Eighty-five percent of the hospitals were recognized for successfully completing all implementation points.

Greene County General Hospital (IN) is recognized for its work in reducing early elective deliveries. Left to right: Jennifer Hurtubise, IHA Representative, Teresa Hutton, RN, OB Manager, Tracy Blanton, RN and Dennis Casey, March of Dimes representative

During the year, the March of Dimes also recognized 272 hospitals in 12 states for their own work to reduce early elective deliveries. All 272 hospitals have a written policy regarding EEDs, which clearly defines medical indications for deliveries at less than 39 weeks and report EED rates less than 5 percent. Two states accounted for 103 of the 272 hospitals. In Indiana, the March of Dimes partnered with the Indiana Hospital Association, and in Florida the March of Dimes partnered with District XII of the American Congress of Obstetricians and Gynecologists (ACOG), the Florida Perinatal Quality Collaborative, the Florida Hospital Association, and the Florida Department of Health to recognize the great work of hospitals in their states.

North Okaloosa Medical Center (FL) is recognized for its work in reducing early elective deliveries.

 1. Oshiro, B., Henry, E., Wilson, J., Branch, D., Varner, M. (2009). Decreasing elective deliveries before 39 weeks of gestation in an integrated health care system. Obstet Gynecol, 113(4), 804-11.
2. Tita, A.T., Landron, M.B., Spong, C.Y., et al. (2009). Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes. N Eng J Med, 360, 111-20.
3. Oshiro, B., Kowalewski, L., Sappenfield, W., et al. (2013). A multistate quality improvement program to decrease elective deliveries