Hospital quality watchdog The Leapfrog Group issued a Call to Action in response to its new findings that thousands of babies are electively scheduled for delivery too early, resulting in a higher likelihood of death, being admitted to a neonatal intensive care unit (NICU), and various life-long health problems.

Despite the importance of this issue to women and babies, Leapfrog said is the first national organization to make this information public by hospital.

No set standards

The findings from 773 hospitals in Leapfrog's 2010 annual hospital survey reveal significant variation among hospitals in their rates of early elective cesarean section and elective inductions, with some hospitals having ten times the rate of others.

Leapfrog CEO Leah Binder said hospitals, health plans, providers, and communities need to do more to protect women and babies from this harmful practice. "And women need to protect themselves by refusing to schedule their deliveries before 39 weeks without a sound medical reason, and by knowing the facts about the hospitals they plan to deliver in," she added.

Binder noted that currently only hospitals that report to Leapfrog's annual hospital survey are making their rates of early elective deliveries public.  "Every hospital should publicly report on their rate and actively prevent the practice, and every woman planning to give birth should demand the information."  

Caution urged

Experts, including those from the American College of Obstetricians and Gynecologists (ACOG), Childbirth Connection and the March of Dimes, caution that the amount of time a baby needs to develop fully -- which includes having a fully developed brain and other organs --is at least 39 completed weeks.

Sometimes there is a medical reason to schedule a newborn delivery before the 39th week -- for example, if the mother has high blood pressure at the end of pregnancy or broken membranes before labor begins.

However, Leapfrog finds many newborns are being "electively" scheduled for delivery before the 39th week, meaning without a medical reason, at alarming rates.

According to the group, hospital rates of early elective deliveries range from less than five percent to more than 40 percent.

The 773 hospitals from around the country that voluntarily provided Leapfrog with information on this measure reported over 57,000 early elective deliveries by cesarean section or induction during the reporting period.


The variation in hospital rates has long been talked about in the health care community, but Leapfrog's release of 2010 data is the first real evidence that the practice of scheduling newborn deliveries before 39 weeks without a medical reason is common and varied among hospitals even in the same state or community.

For example, in the city of Los Angeles, hospitals reported rates as low as 4 percent and as high as 29 percent. In Boston, Leapfrog saw similar variation with some hospitals reporting near 0 and others as high as 27 percent.

In light of these findings, Leapfrog, Childbirth Connection, and the March of Dimes are working together to provide information about the importance of every week of pregnancy with women, purchasers, and others.

Awareness campaign

Leapfrog also announced a Call to Action to other leaders in the health care community to prevent elective deliveries before 39 weeks.  

So far, health insurance companies Aetna, CIGNA, UnitedHealthcare, and WellPoint have all responded to the call and are collaborating on an awareness campaign that includes three key messages:

  • The last weeks of pregnancy are important
  • There are risks for mothers and babies if births are scheduled before 39 weeks for nonmedical reasons
  • Expectant mothers should investigate the rates of elective deliveries for hospitals in their community  

Leapfrog's membership of employers and regional business coalitions plans to help raise awareness by providing Leapfrog data along with resources from Childbirth Connection and the March of Dimes with their employee populations.

Leapfrog also plans to host two national Webinars for health care professionals, focusing on the new 39-week toolkit developed by the March of Dimes and its partners.  

Critical period

Alan R. Fleischman, MD, senior vice president and medical director of the March of Dimes said the last few weeks of pregnancy are critical to a baby's health because important organs, including the brain and lungs, are not completely developed until then.

"We thank Leapfrog for making this data available. A baby's birth should not be scheduled before 39 weeks of pregnancy, unless their health care provider says it's medically necessary. The 39-week toolkit can help ensure that inductions and c-sections are done at the right time and for the right reasons," said Fleischman.

Maureen Corry, executive director for Childbirth Connection, a national advocacy organization that works to improve the quality of maternity care, salutes Leapfrog for making hospital rates of elective delivery accessible so women can make an informed decision about where to give birth.

"Now we need to make the data available for all hospitals and individual physicians and midwives. We are pleased to join Leapfrog's Call to Action by providing women with evidence-based resources on benefits, harms, and appropriate use of labor induction, including tips and tools for avoiding an unnecessary induction,” said Corry.

Setting goals

In 2010, Leapfrog's target for hospitals was a cesarean section and/or induction rate of less than 12 percent of the total number of non-medically indicated deliveries occurring between the 37th and 39th week of gestation.  

In 2011, Leapfrog will lower the target to five percent. This change was made in part because 50 percent of reporting hospitals were able to meet Leapfrog's 12 percent target in 2010 and 29 percent of reporting hospitals exceeded Leapfrog's target by reporting rates of five percent or less.

Additionally, Leapfrog has identified several hospitals and health systems, such as Hospital Corporation of America, which have promoted and supported implementation of policies to deter doctors from scheduling cesarean sections and elective inductions for nonmedical reasons.

The group said this example suggests all hospitals can help implement policies that improve adherence to evidence-based care.