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Dr. James M. NicholsonDr. James Nicholson

A study conducted by researchers at the University of Pennsylvania School of Medicine reports that a cohort of women exposed to a safe, alternative method of maternity care had a 5.3% cesarean delivery rate compared to an 11.8% of women who received more traditional care. The new approach is called the Active Management of Risk in Pregnancy at Term (AMOR-IPAT). AMOR-IPAT evaluates the risk profile for each pregnancy, and uses each risk profile to estimate an optimal time of delivery. Preventive labor induction is used if a woman does not develop spontaneous labor by the upper limit of her optimal time of delivery. Within the term period, the greater the number and severity of risk factors, the earlier preventive labor induction is offered. The study was conducted at a rural New England hospital and involved 1,869 women. The results of this study are similar to a 400-patient study from an urban setting, published in 2009, which reported a 4% cesarean delivery rate in women exposed to AMOR-IPAT.

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Latest News

  • NEW! (2016) Video commentary, published by Contemporary OB/GYN, that looks at the question of whether reducing term births before 39 weeks' gestation leads to a significant increase in the rate of stillbirths and how it may impact practice.

     Video link

    Note: The video cites the following two sources:
    1. Nicholson, James M., et al. (2016), "US term stillbirth rates and the 39-week rule: a cause for concern?" American Journal of Obstetrics and Gynecology 214(5):621.e1-621.e9.

    2. Lockwood, Charles J. (2016), "Fewer elective early term deliveries, more stillbirths?" Contemporary OB/GYN (Published online, 01 May 2016).


  • NEW! (2016) Paper addressing the potential impact of the “39-week rule” on the rates of USA term stillbirths. Because of reported associations between early-term delivery and various neonatal morbidities, an obstetric guideline called “the 39-week rule” was formally implemented in 2010 throughout the USA. The rule restricts “non-indicated” planned delivery prior to 39 weeks of gestation. However, several publications have suggested that the rule, by increasing the mean gestational age of term delivery, might increase population rates of term stillbirth. The objective of this large study was to determine if implementation of the 39-week rule was associated with an increase in the USA rate of term stillbirth.

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  • NEW! (2016) Letter to the Editor expressing concern about the recent collection of articles published in the December 2015 issue of Obstetrics & Gynecology suggesting that the 39-week rule has not increased the rate of U.S. term stillbirth.

    •  Publisher's link


  • Award! (2016) It's official! Dr. Nicholson was awarded the Star Legacy Foundation's first ever Star Legacy Stillbirth Awareness Star Award at the Foundation's 1st annual Gala held on February 13, 2016 in Eden Prairie, MN. As noted on the Foundation's website, "The recipient of this award is someone who has been effective in bringing stillbirth out of the shadows. They have shown the ability to connect with our society to bring attention to the needs of the stillbirth community."

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  • Radio Interview. "AMOR-IPAT: A New Idea to Reduce the Rate of Cesarean Section." This is a November 2008 radio interview with Dr. Lisa Mazzullo, host of ReachMD, XM160, Advances in Women's Health, in which Dr. Nicholson talks about the AMOR-IPAT approach to pregnancy care and how it can help reduce the rate of cesarean section.

    • Audio  •   Transcript


  • CAOI Score Survey
    We are developing a method of evaluating childbirth outcomes called the "Childbirth Adverse Outcome Index Score" (CAOI Score). The CAOI Score will be based on a list of the potential major adverse outcomes that can occur during pregnancy, labor and childbirth, and will assign a numerical value to each outcome. To help facilitate development of this new Score, we are soliciting input from as many interested stakeholders as possible, including pregnant women and/or their partners or other family members, health care providers (doctors, nurses, mid-wives, etc.), insurance providers, hospital administrators, etc. To this end, we encourage you to help us in this research effort by completing this brief, anonymous, online survey.

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  • AMOR-IPAT Bibliography
    Visit the improved and expanded AMOR-IPAT Bibliography. Key new features include article abstracts, free-text searching of all fields and/or progressive filtering by author, year, journal title and keyword.

  • AMOR-IPAT Discussion Forum and Blog
    The AMOR-IPAT Discussion Forum and Blog are now live! These are two great resources for keeping informed about current news, research and ideas related to preventive induction issues, and for sharing your experiences and voicing your opinions.

New Research

Several new research projects are in the planning stage, including:

  • A cost-effectiveness study of the HUP-POP Trial.
  • A study of the relationship between yearly labor induction rates and yearly adverse birth outcomes rates.
  • Possible submission to the NICHD of the NIH for funding for a multi-site R01 RCT proposal involving the use of AMOR-IPAT.

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