This week marks National Hospital Week, and Virginia has something to feel good about: It leads the nation in the lowest number of early elective deliveries, or EEDs.
At a news conference hosted by the Virginia Hospital & Healthcare Association on Tuesday morning in Richmond, physicians and nurses from around the state talked about the importance of the landmark statistic.
“It’s great to see Virginia, which was in the middle of the pack [for states’ EED levels], to now be the leader in the nation,” said Dr. Alta DeRoo, the director of OB-GYN Services at Novant Health UVA Health System Culpeper Medical System.
To illustrate the progress, DeRoo said that in 2013, 11 percent of all deliveries were EEDs. Today that percentage has dropped to nearly zero.
“Occasionally we do have a mother who will come in before 39 weeks,” DeRoo said. “We share the data that the brain, lungs and heart fully develop only after 39 weeks.”
They also put up marketing materials in the hospital like posters illustrating other advantages to full-term delivery, like allowing for spouses or partners to spend more time together before the baby comes, to prepare the nursery and catch up on sleep.
“Whatever the message, it’s consistent: delivery of a baby after 39 weeks is beneficial to both baby and mother,” DeRoo said.
That message reflects national guidelines. In 2013, the American Congress of Obstetricians and Gynecologists (ACOG) revised its definitions of “term” deliveries to include early, full, late and post-term deliveries. The distinctions also included potential health issues within each category, replacing the concept that babies born within the window of 37 to 42 weeks had the same outcomes.
But recent research showed that key developmental processes occur between 37 and 39 weeks and that babies born at 39 weeks or later have better health outcomes than those born before.
After ACOG’s recommendations, EEDs dropped from 17 percent in 2010, to 4.6 percent in 2013.
In Virginia, the overall EED rate went from eight percent in 2012 to 1.3 percent in 2016.
Megan Barefield, a nurse and the director of The Birthplace, a labor, delivery, recovery and postpartum unit at Carilion Clinic’s New River Valley Medical Center in Christiansburg, said they have also seen a drastic decline in EEDs since implementing their own policy changes based on ACOG recommendations.
They have a lot of clinical oversight for scheduling EEDs. “If a physician calls to schedule an induction, only a member of our clinical leadership team can schedule that,” Barefield said.
She added that there was “initial buy-in from nursing and physician leadership recognizing it was an initiative that the hospital wanted to work on.”
They also increased patient education, from the start of pregnancy, she said, and encouraged nurses to question women calling in to schedule an early delivery.
This begs the question of what was driving the higher rates of EEDs?
“The maternal desire to schedule an induction,” Barefield said. “When they’re done being pregnant, they’re done. Physicians want to keep women happy. We didn’t have a practice in place to deter that.”
