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A Brief History of the No Elective Deliveries Before 39 Weeks Campaign

By Jill Arnold

On February 23, 2013, ACOG announced at a press release that it teamed up with the Choosing Wisely campaign and made the following recommendations, among others:

1. Don’t schedule elective, non-medically indicated inductions of labor or cesarean deliveries before 39 weeks 0 days gestational age.
Delivery prior to 39 weeks 0 days has been shown to be associated with an increased risk of learning disabilities and a potential increase in morbidity and mortality. There are clear medical indications for delivery prior to 39 weeks 0 days based on maternal and/or fetal conditions. A mature fetal lung test, in the absence of appropriate clinical criteria, is not an indication for delivery.

2. Don’t schedule elective, non-medically indicated inductions of labor between 39 weeks 0 days and 41 weeks 0 days unless the cervix is deemed favorable.
Ideally, labor should start on its own initiative whenever possible. Higher cesarean delivery rates result from inductions of labor when the cervix is unfavorable. Health care practitioners should discuss the risks and benefits with their patients before considering inductions of labor without medical indications.


Where did the ED<39 week campaign begin?

The California Maternal Quality Care Collaborative authored the original ED<39 week toolkit, under contract from California Department of Public Health and the Maternal, Child and Adolescent Health Division in 2010. March of Dimes licensed the toolkit from the state of California and rebranded it as theirs.


Who wrote letters of support for the toolkit?

The original toolkit appears on the CMQCC web site. Appendix D contains letters of support from the follow groups:

American Congress of Obstetricians and Gynecologists District II (New York)

American Congress of Obstetricians and Gynecologists Illinois Section (District VI)

American Congress of Obstetricians and Gynecologists District IX (California)

American Congress of Obstetricians and Gynecologists FACOG (Florida)

American Congress of Obstetricians and Gynecologists District XI (Texas)

Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN)


More about the history of the toolkit from the CMQCC site:

The Toolkit Development Task Force, with co-chairs Brenda Chagolla, RNC, MSN, CNS, Elliott Main, MD, and Bryan Oshiro, MD, worked collaboratively with the March of Dimes, CMQCC, and the California Department of Public Health, Maternal, Child, and Adolescent Health Division to develop and disseminate this Toolkit.  Academic and clinical leaders in California and across the United States contributed as writers and reviewers.  The goal of the toolkit is to provide guidance and support to obstetric providers, clinical staff, hospitals, and healthcare organizations to develop efficient and successful quality improvement programs to eliminate elective deliveries <39 weeks gestation.



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