Today women eager to deliver and physicians looking to organize their delivery schedules are more likely to be encouraged to wait for the natural process to evolve for both the health of the baby and the mother. Waiting reduces the risk that a newborn will require expensive and risky care in the neonatal intensive care unit, or other developmental problems as the child grows up.
Binder cites two major reasons for the change:
1. Greater transparency through the disclosure of hospitals' rates of early elective deliveries by individual facility name and by state, which Leapfrog began with the first report in an annual series in 2011 for volunteering hospitals.
2. More widespread use of obstetric unit "hard-stop" policies, by which hospitals refuse to schedule any woman's delivery prior to 39 weeks without documented medical necessity.
On transparency, Binder says, "the amount of attention that (the 2011) announcement received was unprecedented for Leapfrog. We did nothing more than report these numbers, but transparency has a big motivational impact."
Binder says that "a lot of quality improvement projects are done with no transparency and are not nearly as successful at changing the culture and the practice. This is not a minor point. So often we start improvement projects in healthcare and we say we're not going to release the data or we hide the data because we don't want anyone to be embarrassed."