Reducing Elective Deliveries Before 39 Weeks

Florida Chapter March of Dimes and Florida Association of Healthy Start Coalitions

Problem Significant increase in number of elective deliveries

between 37 and 39 weeks gestation U.S. labor induction rates more than doubled over

the past decade Majority are non-medically indicated

Associated with increase in C-sections and late pre-term birth

Misconceptions among pregnant women about term gestation and gestational age for safe delivery

34 37

39

Late Preterm

Early Term

Preterm Term

Martin JA, Hamilton BE, Sutton PD, Vendura SJ. Births: Final data for 2006. Natl Vital Stat Rep 2007, 57, no.7. Signore C. No time for complacency: Labor inductions, cesarean deliveries, and the definition of “Term”. Am J Obstet Gynecol, 116(1), July 2010, 4-6.Zhang X, Joseph KS, Kramer MS. Decreased term and postterm birthweight in the United State: impact of labor induction. Am J Obstet Gynecol 2010; 203:124, e1-7.G. March of Dimes (2010). Elimination of Non Medically Indicated Elective Delivery: Quality Improvement Toolkit.

In Florida Only 16% of reporting hospitals had elective

induction rates below 12% 43% of reporting hospitals had rates ranging

from 12.3 – 67% Between 2000 and 2009:

Preterm (<37 weeks gestation) birth rates increased from 12.8% - 14%

Late preterm births (34-36 weeks gestation) account for more than 70% of all preterm deliveries

C-section deliveries increased 50% from 22.5% to 38.1%

Leaprog Group, Hospital Survey, 2010.Florida Department of Health. Op cit.

Florida Disparities in Late Preterm Births

Source: Florida CHARTS

FL Consumer Education Campaign Developed in response to March of Dimes RFP

Goal: To increase consumer knowledge about the importance of the last week’s of pregnancy and their contribution to infant health and development.

Cooperative agreement implemented over three-years.

Campaign Components

Utilize existing MOD’s “39 Weeks/Healthy Babies are Worth the Wait” materials launched nationally June 2011Develop original material for disparate populations (Hispanics, fathers)Coordinate campaign activities with the Florida Perinatal Quality Initiative and a parallel provider education program by the Chiles Center at USFPartner with Florida DOH, major state insurers and experienced social marketing firmsExternal evaluation

Florida’s Consumer Campaign

Priority Coalitions Healthy Start Coalition of Miami-Dade Broward Healthy Start Coalition Children’s Services Council of Palm Beach County Healthy Start Coalition of Southwest Florida Healthy Start Coalition of Hillsborough County Healthy Start Coalition of Sarasota County Healthy Start Coalition of Santa Rosa County

Responsibilities: Participate in and help coordinate “Prematurity Awareness

Day” Kickoff activities Aid in the collection of pre- and post-test survey data in

priority counties Aid in planning, organization, and logistics of focus groups

in priority counties

Responsibilities of all Coalitions Promote the FAHSC 39 weeks website and

overall campaign Participate in pre- and post-training data

collection (survey) Facilitate and participate in educational

trainings for staff, MomCare, case managers, other partner service providers

Current Activities Baseline survey completed!

Information collected on consumer knowledge, beliefs, behavior pre-campaign.

Prematurity Awareness Month activities Website!

www.39weeksFL.org (Consumer & Provider page) Link to FAHSC, local Coalition websites Blog, other social media strategies

Childbirth education curriculum Supplement to FOCEP curriculum, CBE training

Focus groups (Hispanics, fathers)

Baseline Survey Survey developed with state and national expert

input. Sample determined for each of seven counties based

on race/ethnicity and insurance status (insured vs. public or no insurance).

Eligible respondents: pregnant or baby <18 months. 276 surveys completed.

43% between 24-29 years old. One-third no college, one-third some college, one-third

BA/BS 86% lived with partner or another adult About half of pregnant women were between 21-36 wks;

78% of those with children delivered between 37-40 weeks

When are babies full-term?

When is it safe to deliver?

What consumers think. . .

  Strongly Agree

Agree

Neither Agree

nor Disagr

ee

Disagree

Strongly

Disagree

The best delivery plan for a pregnant mom and her baby is to wait for labor to begin on its own.

49.1 38.6 8.2 2.6 1.5

In the last 3-4 weeks of pregnancy, a baby is already fully developed and is just getting bigger.

16.2 45.5 7.9 23.7 6.8

Some doctors and hospitals encourage inducing labor for scheduling convenience.

12.0 38.6 16.5 23.6 9.4

Some doctors and hospitals encourage C-sections and inducing labor to reduce malpractice lawsuits.

10.6 26.4 27.2 25.3 10.6

If a pregnancy is healthy, there is nothing wrong with parents planning an induced delivery with their doctor to have their baby at a certain day and time.

7.2 26.2 20.2 27.8 18.6

Even if your pregnancy has no medical complications, having a baby by C-section has many benefits.

4.5 13.9 19.1 39.7 22.8

Not all consumers are alike. . . Racial differences (Blacks strongest, Whites lowest)

In the last 3-4 weeks of pregnancy, a baby is already fully developed and just getting bigger (p<.0001).

If a pregnancy is healthy, there is nothing wrong with parents planning an induced delivery with their doctor. . .(p=.067)

Pregnant vs. recently delivered (baby <18 months) In the last 3-4 weeks of pregnancy, a baby is. . .just

getting bigger (p=.018) Insurance status (women w/o private insurance

more likely) In last 3- 4 weeks. . . (p=.0001). Even if pregnancy has no complications, having a baby

by C-section has many benefits (p=.067)

Was option of scheduled induction or C-section offered? 19% of pregnant women 49% of new mothers (baby <18 mos)

White women reported being offered option 58.2% of time, Hispanic women 47.7% and Black women 41.4%

Insured women more likely to report being offered option than uninsured or publicly insured women (57% vs. 35.7%)

The people who really do the work. . . Jennifer Salah, project coordinator Wendy Struchen-Shellhorn, PhD, project

evaluator The Healthy Start Coalitions (Miami-Dade,

Broward, Palm Beach, Sarasota, SW FL, Santa Rosa, Hillsborough)

Thank you to the March of Dimes and the Florida Perinatal QI Practice Collaborative

Questions?