Hospital Initiatives Reduce Cesarean Delivery Rates

Strategic quality improvement interventions are associated with a significant reduction in hospital Cesarean delivery rate, according to a new study.

Researchers at Beth Israel Deaconess Medical Center (BIDMC) conducted a study to examine the outcomes of a series of interventions implemented in five obstetric disciplines: interpretation and management of fetal heart rate tracings, provider tolerance for labor, induction of labor, provider awareness of nulliparous, term singleton vertex (NTSV) Cesarean delivery rates, and environmental stress. In some cases, these interventions meant standardizing protocols, increasing provider education, or revising guidelines.

The results showed that during the intervention period, the NTSV Cesarean rate decreased from 34.8% percent to 21.2%. The hospital's overall Cesarean rate also declined, from 40% to 29.1%. An increase in meconium aspiration syndrome and maternal transfusion were also observed. The researchers noted that because the study used a series of interventions, they reported cumulative effects, and therefore could not measure the impact of any single intervention. The impact of midwifery care could was also not measured as it was unavailable until 2014. The study was published in the February 2017 issue of The Joint Commission Journal of Quality and Safety.

“The rate of Cesarean deliveries in low-risk women varies significantly from hospital to hospital across the nation, and such wide disparities suggest that some Cesarean deliveries may be performed for reasons other than medical necessity,” said lead author Mary Vadnais, MD, MPH. “Our research shows that quality improvement initiatives can significantly reduce Cesarean deliveries in low-risk women, benefiting mothers and reducing health care costs.”

“Since implementing these quality improvement measures, our department has seen a steady decline in our Cesarean rate. More important, with that decline we have not seen a clinically significant rise in complications among babies or mothers, which demonstrates the success of the interventions,” said senior author Toni Golen, MD. “Our hope is that other hospitals will replicate this approach by identifying factors within their practice and implement similar quality improvement initiatives, so that they can reduce their Cesarean delivery rates as well.”

A Cesarean section delivery is most commonly performed through a suprapubic low-transverse skin incision. At the end of the operation, the skin incision is typically closed with the placement of either a continuous subcutaneous suture that dissolves over time or multiple metal staples that are removed at a later date. In the United States, 33% of all deliveries are performed by Cesarean section; in China, the rate is as high as 46%.