Elimination of non-medically indicated (elective) deliveries before 39 weeks gestational age


The Elimination of non-medically indicated (elective) deliveries before 39 weeks gestational age toolkit is an important hospital resource that guides and supports obstetrical providers, clinical staff, hospitals and healthcare organizations in implementing a successful quality improvement initiative to eliminate non-medically indicated (elective) deliveries before 39 weeks.

Why was the toolkit developed?

In 2010, the Joint Commission established a new perinatal care core measure set that includes the number of elective deliveries (both vaginal and cesarean) performed at > 37 and < 39 weeks of gestation completed.

In order to support hospitals in eliminating non-medically indicated deliveries before 39 weeks, March of Dimes, California Maternal Quality Care Collaborative (CMQCC), and the California Department of Health, Maternal Child and Adolescent Health Division collaborated on the development of a quality improvement toolkit. The new toolkit includes:

  • Making the Case: A comprehensive literature review about the importance of eliminating elective deliveries before 39 weeks.
  • Implementation: A step-by-step guide to assist hospital leaders with implementation efforts.
  • Data Collection and Quality Improvement: A guide for measuring and tracking QI effectiveness over time.
  • Clinician and Patient Education: Educational tools for clinicians and staff about consequences of early elective delivery; educational tools for patients about the importance of the last weeks of pregnancy.
  • Appendices: Sample Forms, Hospital Case Studies, QI Implementation Tools, Plan-Do-Study-Act (PDSA) Methodology, Implementation Resources and References.

March of Dimes is pleased to make the toolkit available to all hospitals across the country. Interested clinicians, hospitals, insurers and regional collaboratives are invited to download this document to assist in the development of a comprehensive quality improvement program to address elective deliveries <39 weeks. The toolkit was reviewed by the California Department of Public Health Maternal, Child and Adolescent Health Division and is a resource, but it does not define the standard of care in California. Readers are advised to adapt the guidelines and toolkit based on their local facility’s level of care and patient populations and is not to rely solely on guidelines presented here.