Early Elective

Delivery

EED
A policy action plan to reduce the
rate of non-medically indicated
early deliveries in Illinois
Anna Calix

Definition
NQF: a delivery before 39 weeks of gestation without
medical or obstetrical indicationis linked to neonatal
morbidities and mortalities with no benefit to the mother or
infant
AWHONN: on-medically related choicescalled
electiveinclude inducing labor without cause, as well as
birthing via cesarean without a medical reason for surgical
delivery. When these choices are made without cause
before your pregnancy is term, theyre called elective,
early deliveries. Theyre also called dangerous for the
many immediate and life-long risks documented in research
for both you and your baby.
ACOG: performed for a nonmedical reason. Some
nonmedical reasons include wanting to schedule the birth
of the baby on a specific date or living far away from the

Issue: health risks

Illinois overall 2014 EED rate in hospitals was
2% ; ranging from 0-45% 6
EED increases risk of both short term and long
term health problems
Higher morbidity & mortality rates in pre-term
neonates
Maternal: longer labor, increased risk of c-section,
hemorrhage, infection1

Neonatal Morbidity

Source: ACOG,
2013

Morbidities by GA

Neonatal Mortality

Health risks
Moms

Babies

Birth by cesarean,
including the risks of
uncontrolled bleeding
(hemorrhage)
Longer hospital stays
and longer recovery
Anemia
Endometriosis
Urinary tract infections
Sepsis

Prematurity
Low or lower birth
weight
NICU admission
Health complications,
now and life-long
Death, especially in
the first year of life

Source: Healthy Mom & Baby, 2014

Issue: healthcare cost

Overuse of inductions increase both short- and
long-term costs5
An analysis of over 82,000 deliveries occurring
between 37-39 weeks showed there were
significant increases in hospitalization costs for
patients delivered by early elective c-sections7
NICU admission: $50,0009

Solution
Implementation of a policy to decrease the rate of
EEDworks! 50% reduction2
Hard stop policies: most effective
Soft stop policies
Educational programs

Leapfrog Group publicly reporting EED rates

Medicaid policy change

Solution: Other states

Medicaid pays for approximately 50% of births in the
US4
QI initiatives:
Ohio Perinatal Quality Collaborative (OPQC)
participating hospitals reported EED decrease

Medicaid policy change:

Texas HB 1983, Indiana, etc

Solution: Illinois
Medicaid policy change as has been done in
other states, Medicaid will require hospitals to
establish a policy to reduce EED
Exa: Ohio, California

There will be reduced or no reimbursement for

procedures scheduled with no medical indication

Policy entry point

Support from many stakeholders
Letters of support from ACOG, Strong Start &
other organizations
Interested legislators

Sample letter of
support
Source: CA toolkit

Stakeholders
Governmental
CMS: Medicaid
HHS
IDPH

Nongovernmental
Hospitals &
physicians
Insurance
companies
Non-profit &
community based
organizations

March of Dimes
AWHONN
ACOG
IL - EverThrive

Policy paramours
Partner with community, non-profit, and hospital
based organizations to promote policy change
March of Dimes, ACOG, AWHONN

Collaborate with TJC, AHA and other policy making

bodies to develop policy
Identify state legislators who would support the
initiative

Marketing approach
Existing marketing:
AWHONN Healthy Mom
& Baby: Go the full 40
campaign1
Strong Start Initiative
CMS initiative focusing
on 3 major activities:
Promote awareness,
spread best practices,
promote transparency9
EverThrive, March of
Dimes initiatives
Source: GotheFull40 Toolkit

AWHONN Gothefull40
campaign ads

Marketing approach
Print, electronic
& social media
Education
Awareness
Partnerships

Hospitals &
providers
Insurance
companies
General
public/mothers
Legislators

Marketing approach
Education!
A survey of insured women who recently gave birth
found that only 25.2% of women defined full term as
39-40 weeks. But, more importantly, 92.4% of women
reported that giving birth before 39 weeks was safe.
- California toolkit

Resources

Leapfrog Group
Childbirth Connections
March of Dimes
ACOG
AWHONN
Lamaze international
NQF Playbook for the successful reduction of EED
California toolkit for reducing EED
CMS Strong Start toolkit
ACOG list of other relevant organizations:
http://www.acog.org/About-ACOG/ACOGDepartments/Deliveries-Before-39-Weeks/OtherOrganizations

References:
1. 40 reasons to go the full 40. (n.d). Health 4 Mom. Retrieved from:
http://www.health4mom.org/zones/go-the-full-40
2. Avoiding early elective deliveries. Sep 17, 2014. Healthy mom & baby. Retrieved
from: http://www.health4mom.org/avoiding-early-elective-deliveries
3. Elective delivery before 39 weeks. FAQ 181. American College of Obstetricians
and Gynecologists. 2013. Retrieved from: http://www.acog.org/-/media/Forpatients/faq181.pdf?dmc=1&ts=20150713T0028547127
4. Elimination of non-medically indicated (elective) deliveries before 39 weeks
gestational age toolkit. California Department of public health. 2011. Retrieved
from: http://www.leapfroggroup.org/media/file/LessThan39WeeksToolkit.pdf
5. GoTheFull40 campaign toolkit. March 2015. Retrieved from:
http://www.health4mom.org/wp-content/uploads/2015/03/GoTheFull40-Toolkit_V21.pdf
6. Hospital rates of early scheduled deliveries. 2014. The Leapfrog Group.
Retrieved from: http://www.leapfroggroup.org/tooearlydeliveries
7. Important information on HB 1983. 2011. American Congress of Obstetricians
and Gynecologists. Retrieved from: http://www.acog.org/About-ACOG/ACOGDistricts/District-XI/Important-Information-on-HB-1983-and-Less-than-39-Weeks
8. Nonmedically indicated early-term deliveries. Committee Opinion No. 561.
American College of Obstetricians and Gynecologists. Obstet Gynecol 2013;
121:911-5.
9. Strong Start for Mothers and Newborns Initiative: Effort to Reduce Early Elective
Deliveries. (n.d). Center for Medicare & Medicaid. Retrieved from
http://innovation.cms.gov/initiatives/Strong-Start-Strategy-1/index.html