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For more than 30 years, the American College of Obstetricians and Gynecologists has urged obstetric healthcare providers not to initiate elective deliveries (whether vaginal or cesarean) until at least 39 weeks' gestation. A diverse group of community and academic hospitals in the five most populous U.S. states implemented a program to lower rates of preterm elective births. Participating hospitals were required to establish quality-improvement teams led by physicians, train staff on guidelines, and implement strategies including a “hard stop” physician-approval process prohibiting deliveries scheduled before 39 weeks without appropriate medical indications.
In 24 hospitals, 29,030 scheduled singleton births (both elective and medically indi…