33: A statewide initiative to reduce scheduled births without appropriate indication


      To reduce the rate of scheduled births between 36.1 to 38.6 weeks that lack appropriate medical or obstetric indication.

      Study Design

      Level 2 & 3 Ohio maternity hospitals joined a quality improvement collaborative using modified IHI Breakthrough Series methods. 20 hospitals representing 47% of Ohio births collected baseline data for 60 days, then adopted locally appropriate interventions, executed iterative tests of change, and reviewed charts to document the incidence, rationale & outcome of scheduled births. De-identified birth data were sent to a central repository. Rates of scheduled births without a documented medical indication, birth certificate data, and implementation issues were shared in calls and learning sessions.


      The rate of scheduled births between 36.1 and 38.6 weeks without a documented medical indication declined from 25% to below 5% (p < .05) (Fig 1). Birth certificates from member sites recorded fewer inductions without a listed indication, declining from a 12 month mean of 13% to 8% (p < .0027). Fewer infants born at 36-38 weeks went to a NICU. 99% of charts documented dating criteria and 81% met optimal dating criteria.


      A quality collaborative was associated with a significant decline in the rate of scheduled births lacking a documented medical or obstetrical indication.