‘Hard-Stop’ Policy Against Early Elective Deliveries Improves Outcomes

May 7, 2013

New Orleans, LA -- Letting low-risk pregnant patients go into spontaneous labor and delaying non-medically indicated deliveries until 39 weeks’ gestation benefit both mothers and babies, according to new research presented today at the Annual Clinical Meeting of The American College of Obstetricians and Gynecologists.

In the last several years, there has been an increase in cesarean deliveries and labor inductions prior to 39 weeks of pregnancy for non-medical reasons. “Patients get uncomfortable and want to be delivered,” explained Angela Silber, MD, director of maternal-fetal medicine at Summa Akron City Hospital in Ohio. “There might be issues of convenience, such as family members coming to town. Or patients want to be delivered when their doctor is on call.”

In 2009, Summa Akron City Hospital, a member of Summa Health System, implemented a “hard-stop” policy to prevent elective delivery prior to 39 weeks’ gestation. Lead researcher Dr. Silber and her colleagues retrospectively studied 18,503 women who had given birth at the hospital. They focused on macrosomia (large babies), stillbirths, and special or NICU admission rates in all term singleton deliveries prior to implementation of the hard-stop policy (January 2005 through January 2008) and post-policy implementation (January 2010 through June 2012).

Dr. Silber’s analysis found a significant reduction in stillbirths and a lower rate of special or NICU admissions after the hospital implemented its hard-stop policy. There were no significant differences in macrosomia rates.

Avoiding elective delivery prior to 39 weeks’ gestation without a medical indication resulted in improved fetal outcomes, Dr. Silber said. This contradicts previously published literature citing that a policy limiting elective delivery before 39 weeks of gestation actually increased macrosomia and stillbirth rates, she added.

Hard-stop policies are becoming more common, but it will take a large shift before all providers and patients fully accept them, said Dr. Silber. “When we implemented it, there was some push-back from both sides,” she said. “But once it was explained to moms, and they got information regarding brain development and newborn well-being, most patients understood the thinking behind it. And for doctors, it’s a shift in culture toward evidence-based medicine.”

*Tuesday Poster #44: Outcomes after Implementation of a Hard-Stop Policy Limiting Elective Delivery Prior to 39 Weeks

The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 57,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization.


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