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CoIIN: Reducing Non-Medically Indicated Elective Deliveries Prior to 39 Weeks

Evidence suggests that non-medically indicated obstetrical procedures such as elective inductions and scheduled cesarean sections performed prior to 39 weeks have risen sharply in the United States over the past 20 years. Alabama is collaborating with multiple agencies to work toward the elimination of non-medically indicated elective deliveries across the state. The goal of the CoIIN initiative is to decrease to below three percent non-medically indicated deliveries in Alabama or for hospitals to have a hard stop policy in place.

Complications of non-medically indicated elective deliveries before 39 weeks gestation:

  • Increased Neonatal Intensive Care Unit (NICU) admissions
  • Increased risk of irregular heart rhythms
  • Increased risk of respiratory distress syndromes (RDS)
  • Increased risk of infection or sepsis
  • Increased risk for the need for ventilator support
  • Increased problems with feeding tolerance
  • Increased risk of temperature instability


Team Leader

Rosemary Blackmon
Executive Vice President/Chief Operating Officer
Alabama Hospital Association
500 North East Boulevard
Montgomery, AL 36117
Phone: (334) 272-8781
Fax: (334) 270-9527

Team Members

Amy Beard, MSN, RN NEA-BC
Vice President, Womenís Services
Brookwood Medical Center
2010 Brookwood Medical Center Drive
Birmingham, AL 35209
Phone: (205) 877-5399

Joseph R. Biggio Jr., MD
Director, Division of Maternal Fetal Medicine/
Medical Director, Obstetric Services
Associate Professor/ Dept of OB/GYN
University of Alabama at Birmingham
1702  6th Avenue South
Women and Infants Center Suite 10270Q
Birmingham, AL 35249-7333
Phone: (205) 934-6638
Fax: (205) 975-9858

Sylvie Gandy
Quality Director
Alabama Hospital Association
500 North East Boulevard
Montgomery, AL  36117
Phone: (334) 260-7616
Fax: (334) 270-9527

Izza Cagle, MPH
Research Analyst
Maternal & Child Health Epidemiology Branch
Alabama Department of Public Health
201 Monroe Street, Suite 1350
Montgomery, AL  36104
Phone: (334) 206-9448
Fax: (334) 206-0380

Catherine Hanks, RN, BSN, IBCLC
Region IV Perinatal Coordinator
Alabama Department of Public Health
University of South Alabama
Children & Womenís Hospital
Mobile, AL
Phone: (251) 415-1571

Jessica Hardy, MPH, DNP, RN
Director, Office of Women's Health
Alabama Department of Public Health
201 Monroe Street, Suite 710
Montgomery, AL 36104
Phone: (334) 206-5665

Guy M. Middleton, MD, FACOG
1118 Ross Clark Circle, Suite 402
Dothan, AL 36301
Phone: (334) 643-3633
Fax: (334) 836-2893

Cathy Nichols
AWHONN President, Alabama
UAB Medical West
995 9th Ave SW
Bessemer, AL 35022

Claudia M. Reed, RNC-OB, MSN
Clinical Educator/Simulation Coordinator
Mobile Infirmary Health
Education Department
P.O. Box 2144
Mobile, AL 36652
Phone: (251) 435-5133
Fax: (251) 435-3072
Cell: (251) 802-2449

Kimberly Seals
March of Dimes - Alabama Chapter
State Director of Program Services
450 Century Park South Suite 200-B
Birmingham, AL  35226
Phone:  (205) 588-0501

Janice Smiley, MSN, RN
Perinatal Health Division Director
Alabama Department of Public Health
201 Monroe Street, Suite 1346
Montgomery, AL 36104
Phone: (334) 206-2928
Fax: (334) 206-2983

Julia Sosa, MS, RD
Assistant Director Office of Minority Health
Alabama Department of Public Health
RSA Tower Suite 1040
Montgomery, AL 36104
Phone: (334) 206-3812
Fax: (334) 206-3869

Cynthia Williams, CNP, RN FACHE
VP Clinical Organizational Effectiveness
St. Vincentís Health System
810 St. Vincentís Drive
Birmingham, AL 35205
Phone: (205) 939-7537
Fax: (205) 930-2157
Cell: (205) 516-7670

Drew Nelson, MPH
Project Development and Quality Improvement
Managed Care Division
Alabama Medicaid Agency
501 Dexter Avenue
Montgomery, AL  36104
Phone: (334) 353-3216

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