A study published today in Obstetrics & Gynecology shows that multistate, hospital-based quality improvement programs, including the one at Mission Hospital, can be remarkably effective at reducing early elective deliveries of babies.
The rate of elective early term deliveries (i.e., inductions of labor and Cesarean sections without a medical reason) in a group of 25 participating hospitals fell significantly from 27.8 percent to 4.8 percent during the one-year project period, an 83 percent decline.
"Mission Hospital saw a tremendous improvement in the reduction of early deliveries. While much effort was needed to change the mindset of our physicians, after realizing the overall benefits to the babies, the support was overwhelming," said Marvin D. Posner, M.D., Medical Director of Maternal-Fetal Medicine at Mission Hospital. "Our staff worked diligently to achieve these results, and we are so proud to have been part of such an impactful study that not only benefits the lives of babies born here at Mission Hospital, but also sets a precedent for encouraging hospitals across the country to do the same."
The March of Dimes, which partly funded the initiative, says this is good news because babies delivered before full-term are at increased risk of serious health problems and death in their first year of life.
"This quality improvement program demonstrates that we can create a change in medical culture to prevent unneeded early deliveries and give many more babies a healthy start in life," says Bryan T. Oshiro, MD, of Loma Linda University School of Medicine and lead author of the study.
"Reducing unnecessary early deliveries means that more babies stayed in the womb longer, which is very important for their growth and development," Dr. Posner said. "Overall, this project saw a decrease in the proportion of babies born at 37 and 38 weeks and a corresponding increase in the 39-40 plus week range."
Mission Hospital implemented a toolkit called "Elimination of Non-medically Indicated (Elective) Deliveries before 39 Weeks Gestational Age" to guide changes in early term delivery practices. The toolkit was developed in partnership with the March of Dimes, the California Maternal Quality Care Collaborative and the California Maternal Child and Adolescent Division within the California Department of Public Health. Itcan be downloaded free from the Prematurity Prevention Resource Center at prematurityprevention.org.
Mission Hospital is one of the first hospitals in the nation to participate in a collaborative of perinatal quality improvement advocates with state health departments, academic health centers, and March of Dimes chapters from the five most populous states in the country: California, Texas, New York, Florida and Illinois. These five states account for an estimated 38 percent of all births in the United States.
St. Joseph Health's other Orange County hospitals – St. Joseph Hospital in Orange and St. Jude Medical Center in Fullerton, have also adapted and adhere to the March of Dimes guidelines in order to reduce the occurrence of early deliveries.
The March of Dimes urges hospitals, health care providers, and patients to follow American College of Obstetricians and Gynecologists guidelines that if a pregnancy is healthy, to wait for labor to begin on its own. The final weeks of pregnancy are crucial to a baby's health because many vital organs, including the brain and lungs, are still developing.
"A Multistate Quality Improvement Program to Decrease Elective Deliveries Before 39 Weeks," by Dr. Oshiro and others, appears in the April 8 online edition of Obstetrics & Gynecology Vol. 121, No. 5, May 2013.
About Mission Hospital
Mission Hospital provides south Orange County communities with access to advanced care through dozens of locations. Mission Hospital has been serving the greater needs of the community for more than 40 years, improving the quality of life in the communities it serves. Mission Hospital in Mission Viejo, the region's only designated trauma center, offers 24-hour emergency care and specialized services for imaging, heart, stroke, maternity, and women's wellness needs. Mission Hospital Laguna Beach offers 24-hour emergency, intensive and medical-surgical care as well as the South County's only behavioral health services including hospital-based chemical and pain medication dependency treatment. CHOC Children's at Mission Hospital in Mission Viejo is the only dedicated pediatric hospital in South Orange County. Mission is the only hospital to twice earn the Ernest A. Codman Award for Excellence in quality healthcare presented by The Joint Commission for its Traumatic Brain Injury protocol and Rapid Response Nursing Team, and recently earned Magnet® recognition from the American Nurses Credentialing Center. A member of the St. Joseph Health System, Mission Hospital is one of 14 not-for-profit hospitals sponsored by the St. Joseph Health Ministry. For more information, visit mission4health.com.
About the March of Dimes
The March of Dimes is the leading nonprofit organization for pregnancy and baby health. With chapters nationwide and its premier event, March for Babies, the March of Dimes works to improve the health of babies by preventing birth defects, premature birth and infant mortality. For the latest resources and information, visit marchofdimes.com or
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