Reducing C-sections among low-risk, first-birth mothers

Birthing hospitals nationwide have been under pressure to reduce their C-section rates. According to the CDC, the overall C-section rate in the U.S. increased 60% from 1996 through 2009, hitting a high of 32.8% from 2010 to 2012. But hospitals are making steady progress – the CDC reported that in 2018, 31.9% of all births were by C-section.

Although there is a heavy focus on driving down the C-section rate, we know there are situations where this delivery method is the safest option for mother and baby. Because this is major surgery with potential complications, health professionals want to ensure that low-risk mothers are given the appropriate time and support to deliver vaginally. The rate of low-risk C-sections spiked to 28.1% in 2009 but has since come down to 25.9% in 2018. Healthy People 2020 set a national target for low-risk, first-birth c-section deliveries is 23.9% and many states are making great headway. California, for instance, has reached a statewide average of 24.5% for low-risk, first-time births. Although California has not quite reached the 23.9% target, 111 hospitals across the state met or exceeded this goal.

The concern around C-sections has reached a broad, national audience as mainstream media outlets have begun to report individual hospital C-section data. Families can now compare maternal care data online and make informed decisions about where they would like to deliver. In a study from the American Journal of Obstetrics and Gynecology, researchers found that the likelihood of a C-section can depend highly on the hospital in which the woman delivers. Hospitals have become hyper-aware of their C-section rates and are beginning to monitor rates for OB/GYNs and OB nurses individually to ensure compliance and safety.

 

How OB hospitalists can support hospitals in reducing their C-section rates

OB hospitalists play a special role on L&D teams and can make a direct and immediate impact on medically unnecessary C-section rates. Here are some of the ways an OB hospitalist presence can positively impact a hospital’s C-section rate:

  • Because OB hospitalists do not have private practices and are in the hospital 24/7, they have the time to support women during vaginal labor under safe and low-risk circumstances. This eliminates the convenience factor that still exists among some OB/GYNs.
  • OB hospitalists partner with patients and families on a regular basis to help get them through labor via open and honest communication, helping to assuage anxiety and fear.
  • OB hospitalists help with admission and management protocols to help ensure the team doesn’t call for a C-section prematurely.
  • They support midwives, family medical doctors and private OB/GYNs by acting as consultants.
  • Being in the L&D consistently allows OB hospitalists to be more comfortable with fetal heart rate monitoring strips. For instance, being aware of certain categories of tracings that are more serious and may result in a C-section or having the confidence to safely watch a tracing just a little while longer in hopes of a vaginal birth outcome.

One of OBHG's hospital partners recently saw a substantial reduction in their C-section rate. OB hospitalists collaborated with hospital leadership and community physicians to lower the rate from about 40 percent to 20 percent within a three-month span. The team attributes this success to several initiatives, including:

  • Increased awareness and visibility into C-section rates per OB/GYN and even OB nurse
  • Nurses stepping up to become advocates for their patients
  • Weekly team calls to review recent C-sections

This hospital proved that making simple changes in communication could drastically move the needle on their C-section rates.

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If you would like to learn more about how OB hospitalists can support your hospital or OB/GYN practice’s C-section initiatives, please provide the information below and a member of our team will contact you.