Office of Epidemiology and Research, Division of Research

Advancing Applied MCH Research

Oregon's Policy To Reduce Early Term Elective Induction Of Labor: Evaluation Of Impacts On Health And Costs

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Project Number: R40 MC 26809
Grantee: Oregon Health & Science University
Department/Center: Obstetrics And Gynecology
Project Date: 04/01/2014

Final Report


Principal Investigator

Aaron Caughey, MD
Professor and Chair
3181 SW Sam Jackson Park Rd
Portland, OR  972393098
Phone: (503) 418-4500


  • Women/Maternal
  • Prenatal


Childbirth is the most common reason for hospital admission for reproductive aged women and public dollars pay for nearly half of all births in the US. Obstetric intervention is common, has large health and cost implications and deserves rigorous study. Policies to limit elective deliveries, or initiating labor or delivery without medical necessity, have been one approach to improve maternal and neonatal health outcomes and reduce obstetric costs. Elective induction, an intervention to start labor without medical indication for doing so, has risen over the past 3 decades; nearly 500,000 deliveries each year in the US are started using elective induction. Elective induction of labor has become the target of quality improvement initiatives and policies at the national, state, and institutional levels. Such initiatives aim to reduce elective deliveries prior to 39 weeks completed gestation, based on evidence that neonates born during the early term period (37 and 38 weeks completed gestation) have poorer health outcomes and greater resource utilization than infants born at full term (39 or 40 weeks). It is important to understand the population-level health and cost impacts of these initiatives to inform efforts to provide access to high-quality obstetric care for women, improve health outcomes, and reduce costs. This policy analysis utilizes population-based data to comprehensively assess Oregon’s statewide policy designed to restrict elective deliveries prior to 39 weeks completed gestation, known as a "hard-stop". The "hard-stop" was implemented in 2011. It was intended to limit early term deliveries and improve the quality of care and health outcomes for Oregon’s maternal and infant population and. We leverage two data sources, vital registration data and an All-Payer-All-Claims database, unique to Oregon, and a natural experiment to answer key policy questions about the "hard-stop" policy in Oregon: 1) Did the policy reduce the rate of elective deliveries and the proportion of infants born early term (37 and 38 weeks)? 2) Did the policy translate into improvements in infant health? 3) Did the policy reduce delivery and neonatal payments for care and thus save payers and patients money? We have a rare opportunity to take advantage of a natural experiment and a unique data resource, the All-Payer-All-Claims database, to understand policy impacts on a population level. This study will make important contributions to development of obstetric quality measures and result in actionable evidence for hospitals, clinicians, payers, and policymakers.




Labor & Delivery, Health Care Utilization , Health Care Costs, Perinatal

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