Non-Medically Indicated Deliveries <39 Weeks Provider Survey

1. Do you offer or perform non-medically indicated deliveries <39 weeks (deliveries done for non-medical reasons)?

Do you offer or perform non-medically indicated deliveries <39 weeks (deliveries done for non-medical reasons)? Yes

2. When is the earliest gestational age that you feel it is safe to deliver for non-medical reasons?

When is the earliest gestational age that you feel it is safe to deliver for non-medical reasons? <36 weeks

36 weeks

37 weeks

38 weeks

39 weeks

40 weeks

41 weeks

3. Please rank the top three reasons (1 = most often and 3= least often) your patients give when requesting or scheduling a <39 weeks delivery.

	1- Most often	2	3- Least often
Scheduling convenience	*Please rank the top three reasons (1 = most often and 3= least often) your patients give when requesting or scheduling a <39 weeks delivery. Scheduling convenience 1- Most often	Scheduling convenience 2	Scheduling convenience 3- Least often
Uncomfortable, tired of being pregnant	Uncomfortable, tired of being pregnant 1- Most often	Uncomfortable, tired of being pregnant 2	Uncomfortable, tired of being pregnant 3- Least often
Prior pregnancy complications	Prior pregnancy complications 1- Most often	Prior pregnancy complications 2	Prior pregnancy complications 3- Least often
History of rapid labor/lives far away	History of rapid labor/lives far away 1- Most often	History of rapid labor/lives far away 2	History of rapid labor/lives far away 3- Least often
Wants to be delivered by her doctor	Wants to be delivered by her doctor 1- Most often	Wants to be delivered by her doctor 2	Wants to be delivered by her doctor 3- Least often
Not applicable - patients do not request elective deliveries	Not applicable - patients do not request elective deliveries 1- Most often	Not applicable - patients do not request elective deliveries 2	Not applicable - patients do not request elective deliveries 3- Least often

Other (please specify)

4. For healthy normal pregnancies do you present the option of an induction prior to 39 weeks gestation?

For healthy normal pregnancies do you present the option of an induction prior to 39 weeks gestation? Yes

5. For healthy normal pregnancies do you present the option of a scheduled repeat cesarean section prior to 39 weeks gestation?

For healthy normal pregnancies do you present the option of a scheduled repeat cesarean section prior to 39 weeks gestation? Yes

6. Do you think it is safe to delay scheduled non-medically indicated deliveries (elective inductions and elective cesareans) until after 39 +0 weeks?

Do you think it is safe to delay scheduled non-medically indicated deliveries (elective inductions and elective cesareans) until after 39 +0 weeks? Yes

7. If you do not think it is safe to delay scheduled non-medically indicated deliveries until after 39 + 0 weeks, please explain why:

If you do not think it is safe to delay scheduled non-medically indicated deliveries until after 39 + 0 weeks, please explain why:

8. Which of the following do you think will occur if non-medically indicated deliveries <39 weeks are eliminated? (Check all that apply)

Which of the following do you think will occur if non-medically indicated deliveries <39 weeks are eliminated? (Check all that apply) Increase in stillbirths

Increase in macrosomia and/or shoulder dystocia

Increase in preeclampsia

Decrease in stillbirths

Decrease in NICU admissions

Decrease in cesarean deliveries

None of the above

9. Does the possibility of a malpractice lawsuit play a role in your decision for an early term induction?

Does the possibility of a malpractice lawsuit play a role in your decision for an early term induction? Yes

10. Which of the following are valid medical indications for induction < 39 weeks according to ACOG? (Check all that apply)

Which of the following are valid medical indications for induction < 39 weeks according to ACOG? (Check all that apply) Maternal intolerance to late pregnancy

Excess edema, backache, indigestion, insomnia

Prior shoulder dystocia

Suspected fetal macrosomia

All of the above

None of the above

11. In your opinion, what non-ACOG reasons exist for performing inductions <39 weeks?

In your opinion, what non-ACOG reasons exist for performing inductions <39 weeks?

12. What is your preferred method for calculating gestational age for your patients (Choose one)?

What is your preferred method for calculating gestational age for your patients (Choose one)? Last Menstrual Period

First Trimester Ultrasound

Second Trimester Ultrasound

Third Trimester Ultrasound

Doppler FHT + for 30 weeks

+hCG for 36 weeks

Other (please specify)

13. How do you manage patients who present late for care with a prior cesarean section? (Check all that apply)

How do you manage patients who present late for care with a prior cesarean section? (Check all that apply) Deliver at 39 weeks based on best available data

Perform amniocentesis for fetal lung maturity

Wait for onset of labor

Deliver at or after EDC

14. Is there consistency among practitioners at your hospital for calculating gestational age before scheduling a <39 weeks delivery?

Is there consistency among practitioners at your hospital for calculating gestational age before scheduling a <39 weeks delivery? Yes

Unknown

15. Does your hospital currently have any of the below in place?
(Check all that apply)

Does your hospital currently have any of the below in place? (Check all that apply) Hospital policy to eliminate non-medically indicated deliveries <39 weeks

Standardized scheduling guidelines that outline the accepted medical indications for <39 weeks deliveries

Medical leadership which enforces hospital policy that denies scheduled deliveries <39 weeks which do not meet the scheduling guidelines

A quality improvement initiative to eliminate non-medically indicated deliveries <39 weeks

Procedure to collect data on <39 weeks non-medically indicated deliveries

Other (please specify)

16. If your hospital has a <39 weeks delivery policy, could a physician intentionally circumvent it?

If your hospital has a <39 weeks delivery policy, could a physician intentionally circumvent it? Yes

Not applicable – my hospital does not have such a policy

17. If yes, what reason(s) could be used? (Check all that apply)

If yes, what reason(s) could be used? (Check all that apply) Pain

Early labor

Deteriorating fetal status

Other (please specify)

18. Do you think your hospital performs too many early term inductions?

Do you think your hospital performs too many early term inductions? Yes

19. Rank the barriers that your hospital faces in trying to decrease < 39 weeks non-medically indicated deliveries. (1= Largest Barrier and 6= Smallest Barrier)

	1- Largest Barrier	2	3	4	5	6- Smallest Barrier
Physicians’ knowledge of non-medically indicated early term delivery health outcomes vs. full term health outcomes.	*Rank the barriers that your hospital faces in trying to decrease < 39 weeks non-medically indicated deliveries. (1= Largest Barrier and 6= Smallest Barrier) Physicians’ knowledge of non-medically indicated early term delivery health outcomes vs. full term health outcomes. 1- Largest Barrier	Physicians’ knowledge of non-medically indicated early term delivery health outcomes vs. full term health outcomes. 2	Physicians’ knowledge of non-medically indicated early term delivery health outcomes vs. full term health outcomes. 3	Physicians’ knowledge of non-medically indicated early term delivery health outcomes vs. full term health outcomes. 4	Physicians’ knowledge of non-medically indicated early term delivery health outcomes vs. full term health outcomes. 5	Physicians’ knowledge of non-medically indicated early term delivery health outcomes vs. full term health outcomes. 6- Smallest Barrier
Staff knowledge of non-medically indicated early term delivery health outcomes vs. full term delivery health outcomes.	Staff knowledge of non-medically indicated early term delivery health outcomes vs. full term delivery health outcomes. 1- Largest Barrier	Staff knowledge of non-medically indicated early term delivery health outcomes vs. full term delivery health outcomes. 2	Staff knowledge of non-medically indicated early term delivery health outcomes vs. full term delivery health outcomes. 3	Staff knowledge of non-medically indicated early term delivery health outcomes vs. full term delivery health outcomes. 4	Staff knowledge of non-medically indicated early term delivery health outcomes vs. full term delivery health outcomes. 5	Staff knowledge of non-medically indicated early term delivery health outcomes vs. full term delivery health outcomes. 6- Smallest Barrier
Patient knowledge of non-medically indicated early term delivery health outcomes vs. full term delivery health outcomes.	Patient knowledge of non-medically indicated early term delivery health outcomes vs. full term delivery health outcomes. 1- Largest Barrier	Patient knowledge of non-medically indicated early term delivery health outcomes vs. full term delivery health outcomes. 2	Patient knowledge of non-medically indicated early term delivery health outcomes vs. full term delivery health outcomes. 3	Patient knowledge of non-medically indicated early term delivery health outcomes vs. full term delivery health outcomes. 4	Patient knowledge of non-medically indicated early term delivery health outcomes vs. full term delivery health outcomes. 5	Patient knowledge of non-medically indicated early term delivery health outcomes vs. full term delivery health outcomes. 6- Smallest Barrier
Providing real time data for hospital staff about rates of non-medically indicated early term deliveries	Providing real time data for hospital staff about rates of non-medically indicated early term deliveries 1- Largest Barrier	Providing real time data for hospital staff about rates of non-medically indicated early term deliveries 2	Providing real time data for hospital staff about rates of non-medically indicated early term deliveries 3	Providing real time data for hospital staff about rates of non-medically indicated early term deliveries 4	Providing real time data for hospital staff about rates of non-medically indicated early term deliveries 5	Providing real time data for hospital staff about rates of non-medically indicated early term deliveries 6- Smallest Barrier
Consistent support and enforcement by medical leadership.	Consistent support and enforcement by medical leadership. 1- Largest Barrier	Consistent support and enforcement by medical leadership. 2	Consistent support and enforcement by medical leadership. 3	Consistent support and enforcement by medical leadership. 4	Consistent support and enforcement by medical leadership. 5	Consistent support and enforcement by medical leadership. 6- Smallest Barrier
Concern about establishing correct gestational age of the fetus.	Concern about establishing correct gestational age of the fetus. 1- Largest Barrier	Concern about establishing correct gestational age of the fetus. 2	Concern about establishing correct gestational age of the fetus. 3	Concern about establishing correct gestational age of the fetus. 4	Concern about establishing correct gestational age of the fetus. 5	Concern about establishing correct gestational age of the fetus. 6- Smallest Barrier

20. What best influences you to change practice especially on an issue like <39 weeks non-medically indicated delivery? (Rank the top three)

	Most influential	Somewhat influential	Least influential
Published scientific research	*What best influences you to change practice especially on an issue like <39 weeks non-medically indicated delivery? (Rank the top three) Published scientific research Most influential	Published scientific research Somewhat influential	Published scientific research Least influential
ACOG published materials	ACOG published materials Most influential	ACOG published materials Somewhat influential	ACOG published materials Least influential
Grand rounds or other professional education presentations	Grand rounds or other professional education presentations Most influential	Grand rounds or other professional education presentations Somewhat influential	Grand rounds or other professional education presentations Least influential
Hospital policy	Hospital policy Most influential	Hospital policy Somewhat influential	Hospital policy Least influential
Patient demands	Patient demands Most influential	Patient demands Somewhat influential	Patient demands Least influential
Peer-to-Peer sharing	Peer-to-Peer sharing Most influential	Peer-to-Peer sharing Somewhat influential	Peer-to-Peer sharing Least influential

21. Please indicate the hospital level where you maintain privileges and perform most of your deliveries.

Please indicate the hospital level where you maintain privileges and perform most of your deliveries. RPC

Level 3

Level 2

Level 1

I no longer practice obstetrics

22. How long have you been practicing obstetrics?

How long have you been practicing obstetrics? <5 years

6-10 years

11-20 years

21-30 years

>30 years

I do not currently practice obstetrics

23. Which sub-specialty do you practice?

Which sub-specialty do you practice? I am not a sub-specialist

Gyn-Oncology

Reproductive Endocrinology

Maternal-Fetal Medicine

Urogynecology

Other (please specify)

24. Which of the following communication techniques do you prefer to use? (Check all that apply)

Which of the following communication techniques do you prefer to use? (Check all that apply) Webinars

Conference calls

In-person off-site trainings

Hospital grand rounds

Hospital department meetings

Mailed documents

Emails with attachments

Newsletters

25. Would you be willing to serve as an advocate for implementing a comprehensive program at your hospital to eliminate non-medically indicated deliveries < 39 weeks?

Would you be willing to serve as an advocate for implementing a comprehensive program at your hospital to eliminate non-medically indicated deliveries < 39 weeks? No

Yes

If yes, please supply your contact information below:

26. The first 200 individuals to complete this survey will receive a $5 Starbucks gift card. Please include your name and mailing address below.

The first 200 individuals to complete this survey will receive a $5 Starbucks gift card. Please include your name and mailing address below.