Two-Thirds of US Hospitals Now Restricting Non-Medically Indicated Delivery Before 39 Weeks

Hospital Policies Aimed at Reducing Term Babies Admitted to NICU

May 6, 2013

New Orleans, LA -- Nearly two-thirds of all US hospitals handling non-emergency births have instituted policies to eliminate non-medically indicated (NMI) deliveries prior to 39 weeks’ gestation, according to new research presented today at the Annual Clinical Meeting of The American College of Obstetricians and Gynecologists.

Over the last several years, an increasing number of deliveries have occurred prior to 39 weeks’ gestation. However, recent research has shown multiple health risks associated with delivering babies before 39 weeks, including neonatal respiratory distress and admission to neonatal intensive care units (NICU). In an effort to try to reverse the practice, there has been a nationwide movement, including many statewide initiatives, to increase awareness about the harm that NMI 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 on NMI deliveries. Of the 2,367 hospitals that responded, the majority (66.5%) reported having a formal policy in place against the practice, and 33.5% reported no policy. Of the hospitals without a formal policy, 53% said that NMI deliveries were against their standard of care. Of the hospitals with a formal policy, 69% said they had a “hard-stop” policy. A hard-stop policy is a strictly enforced hospital policy against NMI deliveries less at fewer than 39 weeks.

The survey of hospitals also showed that the state initiatives appear to be working in communicating their message. Dr. DeNicola found significantly more hospitals with formal policies in states with quality collaboratives than in states without a quality collaborative. Quality collaboratives refer to 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,” Dr. DeNicola said. “In eighteen 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’ effort 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,” Dr. DeNicola said. “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.”

*Monday Poster #50: Non-Medically Indicated Delivery Prior to 39 Weeks in United States Hospitals

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 more than 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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