“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 Charles Rittenberg, M.D. Asst. Prof. of OB/GYN, MUSC rittenbc@musc.edu (843) 792-3577

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” • 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 thePrematurity Prevention Resource Center at www.prematurityprevention.org.

4. What Do We Need to Get Started • MAP-IT • Mobilize • Assess • Plan • Implement • Track

6. Overview of Changes to the Scheduling Process • Patient is not scheduled and is allowed to go into labor spontaneously • Accurate gestational dating • Appropriate indication for induction or cesarean section for gestational age • Patients can be schedule either by calling the scheduler or faxing in the request • Elective delivers including repeat schedule cesareans sections must be at least 39 weeks gestation based upon ACIOG criteria. • Any scheduling conflicts will be directed to appropriate staff • On going problems are taken care of ASAP or addressed at departmental meetings • Data reported back on regular basis

8. What Providers Can Do • Educate your patients and staff about the risks and benefits of delivery before or after 39 weeks • Perform an ultrasound before 20 weeks to confirm gestation age on all your patients. • Educate your staff on the new scheduling process. • Take a lead on promoting best practices.

9. Tools to Educate Patients Mini grants for up to $100 in educational materials from: www.marchofdimes.com/catalog

10. Healthy Babies are Worth the Wait • Online pledge: • Facebook.com/scmarchofdimes

11. 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.

12. Change in Distribution of Births by Gestational Age: United States, 1990-2006 Source: CDC/NCHS, National Vital Statistics Systems. Martin JA, Hamilton BE, Sutton PD, Ventura SJ, et al. Births: Final data for 2006. National vital statistics reports; vol 57 no 7. Hyattsville, MD: National Center for Health Statistics. 2009.

13. Rates of Induction of Labor by Race and Hispanic Origin in the U.S. Martin JA, Hamilton BE, Sutton PD, Ventura SJ, et al. Births: Final data for 2006. National vital statistics reports; vol 57 no 7. Hyattsville, MD: National Center for Health Statistics. 2009.

14. 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.