In the past several years, there’s been a growing concern about the practice of scheduling deliveries prior to 39 completed weeks of gestation, when there’s no good medical reason to do so. These so-called early elective deliveries (EEDs) have recently been the focus of prevention efforts by the Centers for Medicare & Medicaid Services, the Joint Commission, March of Dimes, Minnesota Department of Human Services, and the Minnesota Hospital Association.
As a result of these efforts, most hospitals in Minnesota have committed to adopting what’s known as a “hard stop” policy to prevent EEDs from being inadvertently scheduled. The core part of the hard stop occurs during the scheduling process. The hard stop literally empowers the scheduler to say no to a planned delivery unless it meets the hospital’s criteria for medical necessity, or is specifically approved by the hospital’s medical leadership.
In an effort to track hospitals’ active participation and provide a rapid feedback method for each facility to self-monitor, we will add a new field to the birth data set in MR&C to indicate whether a hard stop was used for deliveries scheduled at less than 39 weeks’ gestation. Scheduled deliveries include both inductions and C-sections without a trial of labor.
Information about use of the hard stop will be added to the Maternity & Newborn Activity Report, printable from MR&C. In addition, the Maternity & Newborn Activity Report will be modified to include statewide averages for each data field, for you to compare your rates to the rest of Minnesota.
Because the Maternity & Newborn Activity Report will provide a convenient way for facilities to see how they are doing, doctors and hospital administrators may begin asking birth registrars for it – and seeing all of the other data collected and reported at the time of birth. This should bring added recognition to birth registration and encourage clinicians to provide correct/complete information for all birth records.
Although the specifications for the new hard stop field are still under review, we are committed to implementing it late this year. Details will be forthcoming in this newsletter, on the MDH birth registrar’s website and in various listserv emails.
Frequently Asked Questions - "The Case of the Disappearing Dad"
Q - Mom called. She and the father signed an ROP in the hospital, but she just got the Parent Notice from the county and no father’s information appears on the record. And I can’t look up the birth record anymore. Why?
A - The record was created and submitted “pending ROP.” The ROP still hadn’t been filed ten days later, so the birth record auto-filed – without the father’s information. When the status changed from pending to filed, the county sent a Parent Notice. However, this happens after the father’s information has automatically dropped off the record.
Meanwhile, the ROP arrived at OVR and we were able to file it. Because the birth record was already filed (no longer pending), this caused the original version of the record to be replaced with a new one bearing the father’s name.
ROPs and court actions like adjudications and adoptions cause birth records to be replaced. Hospitals do not have access to current records after replacement for security reasons, but you can see the original record – after it was filed without the dad’s information and before it was replaced – by checking the “include replaced records” button at the lower right of the Search Birth Record screen. When you know an ROP is being submitted, you can assume the filing of the ROP caused the replacement.