In 2007, the American Congress of Obstetricians and Gynecologists (ACOG) and the March of Dimes surveyed nearly 20,000 births, which revealed that almost one-third of all babies born in the United States were delivered electively, meaning a delivery scheduled for no accepted medical reason. It also revealed that five percent were scheduled too early—before 39 full weeks of gestation.
Premature and early term babies can have complications and face challenges not normally present in babies born after 39 weeks.
This startling research mobilized several organizations to begin to spread the message that the last weeks of pregnancy are important for healthy maternal and fetal outcomes.
Recently, the Centers for Medicare and Medicaid Services (CMS) teamed up with the March of Dimes to decrease the rate of births electively scheduled at less than 39 weeks of completed gestation. While there are accepted medical reasons to schedule deliveries before spontaneous labor begins, the initiative is directed only at reducing early deliveries scheduled for non-medical reasons, such as patient convenience or hospital scheduling considerations.
As part of this initiative, a “hard stop” policy has been developed and implemented by most Minnesota hospitals to prevent deliveries from being scheduled, prior to 39 full weeks of gestation, for non-medical reasons. This policy empowers the hospital staff scheduling the delivery to stop the scheduling process if there isn’t a documented medical reason and the pregnancy is not at least 39 full weeks.
If a special situation exists to indicate a strong necessity for early delivery, only hospital leadership can override the hard stop. Most hospitals have adopted standardized scheduling tools or worksheets to accompany their policies. These list the accepted medical reasons to schedule deliveries prior to 39 completed weeks gestation.
The next upgrade of MR&C will add a new “hard stop” data field to the birth record when there is a scheduled delivery at less than 39 weeks. Scheduled deliveries are defined as either medically induced births, or cesarean sections performed with no trial of labor. This new mandatory item will be used to track your facility’s use of the hard stop policy.
If the term “hard stop” is unfamiliar, or if you are unaware of your elective delivery scheduling policies, please ask your supervisor or OB leadership at your facility.
The quality of the data collected and reported is dependent on your knowledge and reporting of these data fields in MR&C:
- If the procedure was scheduled for one of the approved medical reasons listed on the standardized scheduling tool, or if the hard stop process was followed and someone in a leadership position reviewed and approved the scheduling of the delivery, answer the hard stop question : YES
- If the procedure was scheduled electively, meaning not for an approved medical reason listed on the scheduling tool or with approval of OB leadership, or if a hard stop policy is not used at your facility, answer the hard stop question: NO
Facilities can monitor their rates of reported hard stop use for early scheduled deliveries with the Maternity & Newborn Activity Report. This report also shows a state average, for comparative purposes.