“39 Weeks and Beyond” Quality Improvement Initiative

1. “39 Weeks and Beyond”Quality Improvement Initiative Megan Branham Director of Programs and Public Affairs South Carolina Chapter mbranham@marchofdimes.com (803) 403-8522

2. 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.

3. 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.

4. 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

5. 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.

6. 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)

7. Preterm Birth Rates by Gestational Age U. S., 1990, 2000, 2005, 2006, 2007*, 2008* Percent *provisional Source: National Vital Statistics Reports Vol. 58, Number 16 April 2010.

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

9. The Gestational Age that Women Considered a Baby Full Term

10. The Gestational Age that Women Consider it Safe to Deliver Obstet Gynecol 2009;114:1254

11. 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

12. 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.

13. Healthy Babies are Worth the Wait www.marchofdimes.com/catalog

14. 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

15. 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