The American College of Obstetricians (ACOG) and the American Academy of Pediatrics (AAP), Association of Women’s Health, Obstetrics, and Neonatal Nurses (AWHONN) have for over 30 years, recommended that elective deliveries prior to 39 weeks gestation without a medical indication should be avoided. According to ACOG one third of all babies are electively delivered in the United States contrary to the aforementioned recommendations. Research supports that performing deliveries prior to 39 weeks gestation without a medical indication leads to increased perinatal and neonatal morbidity.  Furthermore, the AAP has published that elective induction of labor doubles the cesarean birth rate. The purpose of “39 is Fine” program is to decrease the number of elective deliveries performed before 39 weeks gestation at a community hospital in southern California.

Proposed change:

The proposed change is to decrease the overall number of elective deliveries prior to 39 weeks by 20% from the current baseline rate of 39.6% (n=19/48) to make an achievable goal however, the national benchmark is <5%.  

Implementation, outcomes and evaluation:

An interdisciplinary taskforce comprised of nurses and physicians worked in conjunction with a regional collaborative to achieve a community standard. Goals and interventions were established using the ACOG and AWHONN recommendations. The hospital policies and procedures were updated and created to list elective deliveries less than 39 weeks as a contraindication for delivery. The scheduling process was streamlined for both inductions and cesarean births to incorporate a standard form that would require a reason for delivery if less than 39 weeks, verification of gestational age, and informed consent. Physicians and staff were educated on the importance of the initiative and the implementation process. Data was abstracted using computerized software and was analyzed by a labor and delivery nurse for accuracy. Confidential results were provided to each physician to inform them of their data and progress. Results demonstrated a dramatic decline in number of elective deliveries by 14.2% (n=32/143) in the first quarter after implementation and in the second quarter by 24% (n=19/123) exceeding our original goal. Future plans include implementation of a peer review process and a hard stop to prevent elective deliveries less than 39 weeks.    

Implications for nursing practice:

With the establishment of value based medicine, nursing and physicians will need to collaborate to improve quality initiatives and patient outcomes. Nurses should educate their patients of the importance of waiting until 39 completed weeks.

Keywords:

Elective deliveries, 39 weeks, process improvement