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BACKGROUND: Non-medically indicated early deliveries (NMIED) occurring at 37 and 38 weeks gestation have health consequences for both women and newborns, including neonatal respiratory distress, NICU admission and neonatal mortality. An American Journal of Obstetrics and Gynecology study estimated the cost of NMIED to be nearly $1 billion dollars per year and recommends all hospitals implement a hard stop policy to address this practice. We used birth certificate data to estimate NMIED rates and to support ongoing quality improvement initiatives.
METHODS: Applying an algorithm developed by Dr. William Sappenfield based on the Joint Commission perinatal core measure, we examined provisional birth certificate data from 2010-2012 to identify singleton deliveries occurring at 37-38 weeks that were not medically indicated. The algorithm excludes women with potential medical indications for early delivery and infants with specific chromosomal disorders or birth defects. The NMIED rate was then computed as the number of births at 37-38 weeks gestation due to non-indicated induced labor or cesarean section with no trial of labor, divided by the number of births at 37-38 weeks gestation remaining after exclusions. The NMIED rate was calculated for Illinois as a whole, by patient race/ethnicity, payer for delivery, geographic region, perinatal hospital level, and perinatal network. Hospital-specific rates for the 120 birthing hospitals in Illinois were also compared. The Illinois Department of Public Health sent a cover letter and data sheet to every birthing hospital in Illinois.
RESULTS: In 2012, there were 149,778 singleton births in Illinois, 113,998 were eligible for the analysis after exclusions due to medical criteria and missing data, and 28,317 occurred at 37-38 weeks gestation. Of these early term deliveries, 7,070, or 25.0%, were NMIED, a decrease from the rate of 29.6% in 2010. The hospital-specific NMIED rates ranged from 0.0% to 52.4%, and the perinatal network-specific NMIED rates ranged from 13.7% to 32.4%. Non-medically indicated early elective delivery rates were highest among non-Hispanic white women, women who had insurance, and hospitals located in rural counties. Rates did not appear to differ according to level of perinatal care.
CONCLUSIONS: While non-medically indicated early elective deliveries are decreasing in Illinois hospitals, monitoring of this practice remains important. Despite limitations in using birth certificate data, state health departments can use these data to document changes in non-medically indicated early elective deliveries over time and to support the ongoing efforts of birthing hospitals to implement best practices.