Greater awareness among parents and providers of the dangers of choosing to have babies before they are full term has decreased the practice in the United States, but in some areas of the country, early elective deliveries (EEDs) still occur too frequently. A phenomenon of the last 20 years, EED is defined as delivery before 39 weeks without medical or obstetrical indication. It is linked to neonatal morbidity and mortality, and offers no benefit to mothers or infants. Leading professional organizations, including the American College of Obstetricians and Gynecologists, have called for an end to EED, and The Leapfrog Group has documented a decrease among the 1,740 hospitals that participate in its survey, from 17 percent of deliveries in 2010 to 4.6 percent in 2013 — but it still occurs in some hospitals and areas of the country.

In response, the National Quality Forum (NQF) convened a Maternity Action Team that has produced a new Playbook for the Successful Elimination of Early Elective Deliveries. NQF’s Maternity Action Team consists of 24 leading experts. It is co-chaired by Maureen Corry, senior advisor for Childbirth Connection Programs at the National Partnership for Women & Families, and Elliott Main, MD, medical director of the California Maternal Quality Care Collaborative.

“The Playbook is the latest installment in NQF’s robust body of work in EEDs,” said Wendy Prins, MPH, MPT, vice president for National Quality Partners at NQF. “This work would not be possible without the partnership of NQF members like the National Partnership for Women & Families and all of our action team members, whose expertise and experience play an important role in informing our work and inspiring and generating results.”

The 27-page Playbook is available free online. It provides guidance and strategies to end EED, including:

• Analysis of programs, techniques and levers that have been used successfully to reduce EED;
• A description of barriers that medical leaders, hospitals, and health systems may encounter as they work to reduce EED, and strategies to overcome those barriers. Barriers include provider resistance to change, lack of accountability, lack of 24-hour anesthesia coverage at some hospitals, lack of awareness among women of the risks associated with EED, and more;
• A discussion of challenges and barriers that impede monitoring performance and progress in eliminating EED;
• Key strategies to promote readiness for EED reduction among senior leaders and those shaping health policy and payment systems;
• Guidance for measuring and reporting progress in eliminating EED; and
• A comprehensive list of educational tools, resources and exemplars to support EED reduction.

“Statewide variation in EED still speaks to the need for a concerted multifaceted effort to eliminate EED, said Main. “The Playbook captures the collective knowledge of an all-star team of leaders championing quality maternity care to guide this work.”

“Widespread use of the Playbook can help us finish the job of ending EED, thereby improving the health of mothers and babies,” Corry said. “This document shares best practices and provides specific guidance for hospitals and hospital systems facing barriers and challenges in their efforts to improve the quality of maternity care. Our hope is that it will soon be in the hands of every maternity care provider, health care leader and policymaker working to make childbirth safer for mothers and babies.”

More information on this initiative is available here. The Maternity Action Team supports the work of the Partnership for Patients, a public-private partnership working to improve the quality, safety and affordability of health care for all Americans.