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Delivering Safety Over Convenience

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   September 25, 2013

Driven by safety evidence and new reporting requirements, obstetric units are curbing elective early deliveries. But some patients are insistent.

This article appears in the September issue of HealthLeaders magazine.

The well-heeled women planning to give birth at 451-bed Valley Hospital in Ridgewood, N.J., have been a tough crowd to please.

Most are affluent, with 95% covered by private insurance, and many work in high-pressure jobs 25 miles away in Manhattan. "They have things they do in their lives every day, and they schedule everything, including how and when they have their babies," says Claire Grande, RN, Valley's assistant vice president of women's and children's services.

"They'd say they need to schedule their deliveries early because on their regular due date they need to attend a conference. Or their mom is coming from Texas but can only stay a week. Or she needs to schedule now because she's too uncomfortable; her back is killing her." And with this demographic, they're used to getting what they want, Grande says.

So a few years ago, when key studies began to amass evidence of the significantly greater chances that babies born before 39 weeks would develop cognitive disabilities or pulmonary function problems, or would require time in an expensive neonatal intensive care unit, Valley officials knew they had to make some changes.

They'd need to stop medically unnecessary early deliveries that their patients were insisting on, and that their obstetricians were willingly performing, either for the patient's or the physician's convenience. Valley's rate in 2009 was an unacceptable 31.2%, far higher than recommendations from professional groups.

"We knew we had a lot of work to do," Grande says.

With guidance from the American Congress of Obstetricians and Gynecologists and the New Jersey Hospital Association, as of 2013, Valley's rate of early avoidable elective deliveries has dropped to 3.1%.

Mitchell Rubinstein, MD, Valley's chief medical officer and vice president of medical affairs and education, notes that some people may question how much impact "an additional one or two or three days' gestation can have on a baby."

But he says buy-in from the C-suite was robust. "We could not ignore the strong recommendations from organizations such as the March of Dimes and the ACOG. This was clearly an issue of safety versus convenience, and it would be inexcusable for safety not to win."

Now, hospitals across the country are ramping up efforts to monitor and reduce their elective early deliveries, or they should be, because money and reputations are at stake. Starting Jan. 1, The Joint Commission mandates that as a condition of accreditation, any hospital with at least 1,100 births a year will have to report five new obstetric measures, including preterm elective deliveries and C-sections.


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