39+ Weeks Quality Improvement

Eliminating Elective Deliveries before 39 Weeks Gestational Age

The rate of labor induction in the United States has more than doubled since 1990. In 2006, more than 22 percent (roughly 1 out of every 5) of all pregnant women had their labor induced.   Much of this rise has been attributed to an increase in elective inductions without a medical reason. However, elective deliveries before 39 weeks gestational age carry significant risks for the baby with no known benefits to the mother. Quality improvement interventions supported by strong leadership and policy enforcement have been shown to be effective in reducing elective deliveries before 39 weeks gestational age.

Elimination of Non-medically Indicated (Elective) Deliveries Before 39 Weeks Gestational Age Toolkit
With the goal of helping hospitals to eliminate elective deliveries before 39 weeks, the March of Dimes California Chapter, the California Quality Care Collaborative (CMQCC), and the California Maternal Child and Adolescent Division within the State Department of Public Health created a Toolkit. Download a free copy of the Toolkit.
To test the effectiveness of the <39 Weeks Toolkit, the March of Dimes partially funded a study to pilot the Toolkit in 25 hospitals in five states where almost 40 percent of the births in the United States occur – California, Florida, Illinois, New York and Texas. The multi-state, hospital-based quality improvement program was remarkably effective at reducing early elective deliveries of babies. The rate of elective singleton early term deliveries (i.e., inductions of labor and cesarean sections without a medical reason) in the hospitals fell significantly from 27.8 percent to 4.8 percent during the 1-year project period, an 83 percent decline. The study was published in the journal Obstetrics & Gynecology in April 2013. More information can be found by clicking here.

39+ Weeks Quality Improvement Service Package
Building upon the Toolkit and the pilot study, the March of Dimes developed the 39+ Weeks Quality Improvement (QI) Service Package to support hospitals in implementing a successful quality improvement initiative to eliminate elective deliveries prior to 39 weeks. Click here to watch a short introduction video about the initiative and here to view an informational brochure. Components that make the program unique: 

  • A complete, packaged solution including action-oriented guidance, data collection and reporting tools, patient education and other support services to maximize a hospital’s success in attaining its quality improvement goals
  • Grand Rounds presented by speakers from the renowned March of Dimes National Speakers Bureau
  •  Step-by-step toolkit implementation guidance provided via archived webinars presented by content leaders from across the country with expertise in perinatal care and quality improvement (CMEs/CNEs provided for selected webinars)
  • Secure web-based data portal that generates monthly and quarterly reports detailing key indicators and outlining change from previous months
  • Monthly “Ask the Expert” calls led by March of Dimes perinatal and quality improvement experts

39+ Weeks Quality Improvement Hospital Learning Collaboratives

To help hospitals implement a successful perinatal quality improvement initiative to eliminate non-medically indicated deliveries prior to 39 weeks, the March of Dimes works with hospitals and health systems to tailor learning collaboratives to address the specific needs of the hospitals in the collaborative.  Components may include:

  • Webinars to discuss the evidence for implementing a strategy to reduce early elective deliveries
  • Grand Rounds presented by speakers from the renowned March of Dimes National Speakers Bureau
  •  In-depth, on-site mentoring sessions (in conjunction with Grand Rounds) to provide focused and tailored guidance and support
  • A series of “Ask the Expert” calls led by March of Dimes perinatal and quality improvement experts

Hospitals, hospital systems, hospital engagement networks or others interested in purchasing a March of Dimes 39+ Weeks QI Service Package or Tailored Hospital Learning Collaborative should contact 39weeksQI@marchofdimes.org

Hospital Recognition to Reduce Elective Deliveries before 39 Weeks

The March of Dimes would like to recognize the following hospitals for meeting the criteria of the March of Dimes 39+ Weeks Quality Improvement Service Package: 

  • Athens Regional Medical Center, Athens, GA
  • Atlanta Medical Center, Atlanta, GA
  • Baptist Health Lexington, Lexington, KY
  • Baptist Health Louisville, Louisville, KY
  • Baptist Hospital of SE Texas, Beaumont, TX 
  • Bethesda Hospital, Boynton Beach, FL 
  • Broward Health, Fort Lauderdale, FL
  • Cape Coral Hospital, Cape Coral, FL 
  • Centennial Hills Hospital Medical Center, Las Vegas, NV
  • CHRISTUS Spohn Hospital Alice, Alice, TX 
  • Columbus Regional Health, Columbus, IN
  • DeKalb Health, Auburn, IN
  • Edward Hospital, Naperville, Ill
  • El Centro Regional Medical Center, El Centro, CA
  • Floyd Memorial Hospital and Health Services, New Albany, IN
  • Genesis Medical Center, Davenport, IA 
  • Grady Memorial Hospital, Atlanta, GA
  • Halifax Health, Daytona Beach, FL
  • Hardin Memorial Hospital, Louisville, KY
  • Hartford Hospital, Glastonbury, CT 
  • Health Park Medical Center, Ft. Myers, FL
  • Henrico Doctors’ Hospital, Richmond, VA 
  • Hoag Memorial Hospital Presbyterian, Newport Beach, CA
  • Hurley Medical Center, Flint, MI
  • Inova Fairfax Hospital, Falls Church, VA 
  • Katherine Shaw Bethea Hospital, Dixon, IL.
  • Manchester Memorial Hospital, Manchester, CT 
  • Mission Hospital, Mission Viejo, CA
  • Mobile Infirmary, Mobile, AL
  • McLeod Medical Center, Dillon, SC 
  • North Mississippi Medical Center, Tupelo, MS 
  • Pekin Hospital, Pekin, IL
  • Providence Health Center, Waco, TX
  • Riverside Shore Memorial Hospital, Nassawadox, VA
  • Sierra Providence East Medical Center, El Paso, TX
  • Sharp Chula Vista Medical Center, Chula Vista, CA
  • South Miami Hospital, Miami, FL
  • Spring Valley Hospital Medical Center, Las Vegas, NV
  • Summerlin Hospital Medical Center, Las Vegas, NV
  • St. Elizabeth's Baptist Hospital, Belleville, Ill.
  • St. Joseph Medical Center, Houston, TX
  • St. Joseph's Women's Hospital, Tampa, FL.
  • St. Luke's Regional Medical Center of Sioux City, Sioux City, IA
  • St. Mary's Hospital and Regional Medical Center, Grand Junction, CO 
  • The Woman’s Hospital of Texas, Houston, TX
  • Thomas Hospital, Fairhope, AL 
  • Touchette Regional Hospital, Centreville, IL
  • Tulare Regional Medical Center, Tulare, CA 
  • Union Hospital, Terre Haute, IN
  • University of Illinois, Chicago, IL.
  • University Medical Center of Southern Nevada, Las Vegas, NV.
  • UNM Hospitals, Albuquerque, NM
  • Valley Hospital Medical Center, Las Vegas, NV
  • VCU Medical Center, Richmond, VA 
  • West Georgia Medical Center, LaGrange, GA 
  • Winnie Palmer Hospital, Orlando, FL


See also: Less than 39 weeks toolkit, Prematurity Prevention Resource Center (PPRC), A Multistate Quality Improvement Program to Decrease Elective Deliveries Before 39 Weeks of Gestation, 39+ Weeks Quality Improvement Initiative Marketing Video, Healthy Babies are Worth the Wait® (PDF, 198 KB)