One year ago, the Leapfrog Group released results of their annual Hospital Survey, for the first time publicly reporting rates of early elective deliveries (inductions or planned c-sections occurring before 39 weeks without a medical reason). The results were shocking, with hospitals varying from virtually zero to well over half of elective deliveries occurring before 39 completed weeks. Last week, we partnered again with the Leapfrog Group and other organizations to publicize the release of this year’s survey results, and we’re pleased that the data show rates moving in the right direction.
Posts tagged with 'cesarean'
Our Leading Change series profiles leaders in efforts to transform maternity care. This month we bring readers an interview with Christine Morton, PhD, a medical sociologist at the California Maternal Quality Care Collaborative. Christine and I discuss the rising rate of maternal mortality, how standardizing care for obstetric hemorrhage can help, the need for better data collection and reporting, and how state quality collaboratives can lead change. Thanks Christine for taking the time to answer these questions, and thanks everyone at CMQCC for your work to transform maternity care!
As a Patient-Centered Maternity Home, two components of our Maternal-Child Health Care are evidence-based practice and shared decision-making. While ACOG guidelines are not always evidence-based, they have recently released guidelines allowing us all to offer trial of labor to women with two prior cesareans or twins. Our cesarean rate is 19% and our VBAC rate is 50%. North Carolina Medicaid is currently reimbursing cesarean birth at the same rate as vaginal birth.They were proactive in setting the rates pretty close to each other in years past.
You’ve probably heard the phrase, “Will it play in Peoria?” It originated in the early ’20s and ’30s during the US vaudeville era, when Peoria, IL was a popular stop for vaudeville acts and performances. If a show was well received in Peoria, it was likely to work throughout the country. Peoria has since become a well-known test market to gauge the popularity of products and ideas nationwide.
So what does this have to do with maternity care? Well, in this case, what’s playing in Peoria goes way beyond products and ideas to a full-blown actionable healthcare quality improvement project called “Healthy Babies, Healthy Moms.”
As we shift the conversation from whether to do VBACs to how to enable more of them, focus on quality and safety in the context of VBAC is long overdue. According to new government statistics, nearly one in five of the more than 4 million births each year in the United States occur to women who have previously given birth by cesarean. If evidence supports VBAC as a “reasonable option” for most of this population and indeed the better option for many, it is time to be reasonable about how to make VBAC as safe, accessible, and satisfying as it can possibly be.
With power outages and last-chance summer vacations, it feels a bit like life has slowed down in anticipation of the busyness that comes with fall. But while conference calls and meetings are a little sparser, the medical literature seems to be serving up a larger than average helping of important evidence and commentary. Maybe your Labor Day Weekend reading list has lighter fare, but here’s what we’re reading…
In the Literature: San Francisco General Hospital implements skin-to-skin care in the operating room for mothers and infants after cesarean surgery
The improvement team altered the process of care in the operating room to enable routine, early skin-to-skin contact after cesarean birth, with the aim of increasing the success of breastfeeding initiation.
For all scheduled cesarean deliveries, the hospital introduced a preoperative checklist to verify patient identity, indication for caesarean section, allergies, and presence of neonatology staff and a postoperative check to verify analgesia, oxytocic prescription, antibiotics, thromboprophylaxis and skin contact between mother and baby. Researchers examined staff attitudes before and after introduction of the checklists, checklist compliance, and whether patients experienced anxiety or were reassured by the process.
In the Literature: At Intermountain, process improvement reduces inductions, cesareans, NICU admissions, and costs
As a result of process improvement efforts bolstered by robust information systems, the proportion of all inductions that lacked strong indications for clinical appropriateness fell from 28 percent to less than 2 percent. The project also resulted in decreases in both NICU admissions and cesareans, and Intermountain estimates that the elective induction protocol reduces health care costs in Utah by $50 million per year.
We set out to change the method that is used to measure the results of different labor management strategies. We created an indicator that uses each patient’s unique physical characteristics to adjust an obstetrical care provider’s cesarean delivery rate to reflect the physical characteristics of their patient population. This indicator is called the Birthrisk Cesarean Birth Measure.