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 Late Preterm Early Term PretermTerm Martin JA, Hamilton BE, Sutton PD, Vendura SJ. Births: Final data for 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, 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 2011  Develop 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 USF  Partner with Florida DOH, major state insurers and experienced social marketing firms  External 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!  (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 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 wks; 78% of those with children delivered between weeks

When are babies full-term?

When is it safe to deliver?

What consumers think... Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree The best delivery plan for a pregnant mom and her baby is to wait for labor to begin on its own In the last 3-4 weeks of pregnancy, a baby is already fully developed and is just getting bigger Some doctors and hospitals encourage inducing labor for scheduling convenience Some doctors and hospitals encourage C-sections and inducing labor to reduce malpractice lawsuits 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 Even if your pregnancy has no medical complications, having a baby by C-section has many benefits

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?