Reducing Elective Deliveries Before 39 Weeks

1. Reducing Elective Deliveries Before 39 Weeks Florida Chapter March of Dimes and Florida Association of Healthy Start Coalitions

2. Problem • Significant increase in number of elective deliveries between 37 and 39 weeks gestation • U.S. labor induction rates more than doubled over the past decade • Majority are non-medically indicated • Associated with increase in C-sections and late pre-term birth • Misconceptions among pregnant women about term gestation and gestational age for safe delivery Preterm Term Late Preterm Early Term 34 37 39 Martin JA, Hamilton BE, Sutton PD, Vendura SJ. Births: Final data for 2006. Natl Vital Stat Rep 2007, 57, no.7. Signore C. No time for complacency: Labor inductions, cesarean deliveries, and the definition of “Term”. Am J Obstet Gynecol, 116(1), July 2010, 4-6. Zhang X, Joseph KS, Kramer MS. Decreased term and postterm birthweight in the United State: impact of labor induction. Am J Obstet Gynecol 2010; 203:124, e1-7.G. March of Dimes (2010). Elimination of Non Medically Indicated Elective Delivery: Quality Improvement Toolkit.

3. In Florida • Only 16% of reporting hospitals had elective induction rates below 12% • 43% of reporting hospitals had rates ranging from 12.3 – 67% • Between 2000 and 2009: • Preterm (<37 weeks gestation) birth rates increased from 12.8% - 14% • Late preterm births (34-36 weeks gestation) account for more than 70% of all preterm deliveries • C-section deliveries increased 50% from 22.5% to 38.1% Leaprog Group, Hospital Survey, 2010. Florida Department of Health. Op cit.

4. Florida Disparities in Late Preterm Births Source: Florida CHARTS

5. FL Consumer Education Campaign • Developed in response to March of Dimes RFP • Goal: To increase consumer knowledge about the importance of the last week’s of pregnancy and their contribution to infant health and development. • Cooperative agreement implemented over three-years.

6. Campaign Components • Utilize existing MOD’s “39 Weeks/Healthy Babies are Worth the Wait” materials launched nationally June 2011 • Develop original material for disparate populations (Hispanics, fathers) • Coordinate campaign activities with the Florida Perinatal Quality Initiative and a parallel provider education program by the Chiles Center at USF • Partner with Florida DOH, major state insurers and experienced social marketing firms • External evaluation

7. Florida’s Consumer Campaign

8. Priority Coalitions • Healthy Start Coalition of Miami-Dade • Broward Healthy Start Coalition • Children’s Services Council of Palm Beach County • Healthy Start Coalition of Southwest Florida • Healthy Start Coalition of Hillsborough County • Healthy Start Coalition of Sarasota County • Healthy Start Coalition of Santa Rosa County • Responsibilities: • Participate in and help coordinate “Prematurity Awareness Day” Kickoff activities • Aid in the collection of pre- and post-test survey data in priority counties • Aid in planning, organization, and logistics of focus groups in priority counties

9. Responsibilities of all Coalitions • Promote the FAHSC 39 weeks website and overall campaign • Participate in pre- and post-training data collection (survey) • Facilitate and participate in educational trainings for staff, MomCare, case managers, other partner service providers

10. Current Activities • Baseline survey completed! • Information collected on consumer knowledge, beliefs, behavior pre-campaign. • Prematurity Awareness Month activities • Website! • www.39weeksFL.org (Consumer & Provider page) • Link to FAHSC, local Coalition websites • Blog, other social media strategies • Childbirth education curriculum • Supplement to FOCEP curriculum, CBE training • Focus groups (Hispanics, fathers)

11. Baseline Survey • Survey developed with state and national expert input. • Sample determined for each of seven counties based on race/ethnicity and insurance status (insured vs. public or no insurance). • Eligible respondents: pregnant or baby <18 months. • 276 surveys completed. • 43% between 24-29 years old. • One-third no college, one-third some college, one-third BA/BS • 86% lived with partner or another adult • About half of pregnant women were between 21-36 wks; 78% of those with children delivered between 37-40 weeks

12. When are babies full-term?

13. When is it safe to deliver?

14. What consumers think. . .

15. Not all consumers are alike. . . • Racial differences (Blacks strongest, Whites lowest) • In the last 3-4 weeks of pregnancy, a baby is already fully developed and just getting bigger (p<.0001). • If a pregnancy is healthy, there is nothing wrong with parents planning an induced delivery with their doctor. . .(p=.067) • Pregnant vs. recently delivered (baby <18 months) • In the last 3-4 weeks of pregnancy, a baby is. . .just getting bigger (p=.018) • Insurance status (women w/o private insurance more likely) • In last 3- 4 weeks. . . (p=.0001). • Even if pregnancy has no complications, having a baby by C-section has many benefits (p=.067)

16. Was option of scheduled induction or C-section offered? • 19% of pregnant women • 49% of new mothers (baby <18 mos) • White women reported being offered option 58.2% of time, Hispanic women 47.7% and Black women 41.4% • Insured women more likely to report being offered option than uninsured or publicly insured women (57% vs. 35.7%)

17. The people who really do the work. . . • Jennifer Salah, project coordinator • Wendy Struchen-Shellhorn, PhD, project evaluator • The Healthy Start Coalitions (Miami-Dade, Broward, Palm Beach, Sarasota, SW FL, Santa Rosa, Hillsborough) • Thank you to the March of Dimes and the Florida Perinatal QI Practice Collaborative

18. Questions?