The second major influence, hard stop policies in the obstetric units, has changed the culture of obstetrician gynecologists. "At least in hospitals we've spoken with where we see massive improvement, they've made it more difficult to schedule these deliveries," she says.
"When they put in place a policy that these deliveries can not be scheduled without a medical reason—and if a physician wants to schedule a delivery, they need to go through a process to get it approved—that pretty much lowers the rate pretty quickly."
The Leapfrog program encourages hospitals with at least 50 births a year to voluntarily report to the organization, and the list of those that do continues to climb, with 200 more hospitals reporting for 2013 than reported for 2010.
In recent years, several researchers have published findings showing that women who give birth before 39 weeks or pregnancy run a higher risk of delivering babies with developmental disabilities and neurocognitive problems. Other reports suggest that the mother herself is at greater risk of complications, such as excessive bleeding, when babies are delivered before they're ready.