Purpose for the Program
For more than 30 years, the American College of Obstetricians (ACOG), the American Academy of Pediatrics (AAP), and the Association of Women's Health, Obstetrics and Neonatal Nurses (AWHONN) have recommended that elective deliveries prior to 39 weeks gestation without a medical indication be avoided. According to ACOG, one third of all infants are electively delivered in the United States contrary to the aforementioned recommendations. Research supports that performing deliveries prior to 39 weeks gestation without a medical indication leads to increased perinatal and neonatal morbidity. Furthermore, the AAP has published that elective induction of labor doubles the cesarean birth rate. The purpose of the 39 is Fine program is to decrease the number of elective deliveries performed before 39 weeks gestation at a community hospital in southern California.
To decrease the overall number of elective deliveries prior to 39 weeks gestation by 20% (to make an achievable goal) from the current baseline rate of 39.6% (n = 19/48); however, the national benchmark is less than 5%.
Implementation, Outcomes, and Evaluation
An interdisciplinary taskforce composed of nurses and physicians worked in conjunction with a regional collaborative to achieve a community standard. Goals and interventions were established using the ACOG and AWHONN recommendations. The hospital policies and procedures were updated and created to list elective deliveries less than 39 weeks gestation as a contraindication for delivery. The scheduling process was streamlined for inductions and cesarean births to incorporate a standard form that would require a reason for delivery if the patients were less than 39 weeks gestation, verification of gestational age, and informed consent. Physicians and staff were educated on the importance of the initiative and the implementation process. Data were abstracted using computerized software and were analyzed by a labor and delivery nurse for accuracy. Confidential results were provided to each physician to inform them of their data and progress. The results exceeded the original goal and demonstrated a dramatic decline in the number of elective deliveries from 14.2% (n = 32/143) in the first quarter after implementation to 24% (n = 19/123) in the second quarter. Future plans include implementation of a peer review process and a hard stop to prevent elective deliveries less than 39 weeks gestation.
Implications for Nursing Practice
With the establishment of value-based medicine, nursing and physicians will need to collaborate to improve quality initiatives and patient outcomes. Nurses should educate their patients of the importance of waiting until completing 39 weeks gestation before giving birth.