Almost one-third of births in the United States occur via cesarean section—that’s twice the 10-15% rate the World Health Organization considers ideal. Although some of these C-sections are lifesaving, many others are performed unnecessarily due to some patients believing common myths about the procedure—such as C-sections being easier on the body than vaginal births—or providers being overly cautious about factors such as fetal monitoring readings.
When not medically necessary, these procedures can be harmful to both patients and hospitals alike, as they are costly and present risks to mothers and infants. One major risk is maternal death, as the American College of Obstetricians and Gynecologists found that about 13 deaths per 100,000 women occur after C-sections compared to four per 100,000 women for vaginal birth. Other potential risks include surgical site infections, hemorrhage, and longer recovery times.
To avoid these risks and reduce costs, many organizations are implementing initiatives to reduce C-section rates for low-risk pregnancies, some of which are highlighted below.
- Leverage Data Transparency: To cut its C-section rates, TriHealth focused on raising physician awareness by publishing each OB-GYN’s rate every month in a blind fashion. Upon seeing this data, physicians with high rates questioned their practices and found ways to reduce instances of C-sections, such as allowing mothers more time in labor. As a result of these efforts, TriHealth’s C-section rate decreased from 36% to 24.6% in just two years.
- Shift Hospital Culture: After data transparency efforts alone failed to cut C-section rates at Doctors Hospital, the organization worked to change hospital culture by having all staff undergo a fetal monitoring course to learn the proper use of the practice for low-risk women. This initial intervention, combined with continued data transparency, reduced the organization’s C-section rate to 24%. However, additional efforts were needed to modify the hospital’s culture after its C-section rate spiked again, so a laborist service was hired to surpass physicians’ time constraints and allow mothers more time in labor.
- Focus on Targeted Interventions: Identifying areas of improvement and implementing interventions accordingly can help organizations reduce C-section rates. Beth Israel Deaconess Medical Center, for example, implemented five quality improvement initiatives targeted at interpretation and management of fetal heart rate tracings, provider tolerance for labor, induction of labor, provider awareness of low-risk C-section rates, and environmental stress. As a result of these interventions, the organization’s low-risk C-section rate decreased from 34.8 % to 21.2%.
- Change Physician Behavior: Providers at Hoag Memorial Hospital Presbyterian needed to move quickly once insurers questioned the organization’s 38% C-section rate. To reduce this rate, the organization took the radical measure of non-anonymously sharing the C-section rate of every OB-GYN, with many physicians changing their practices as a result. The hospital also modified its labor scheduling system, stepped up its patient education, asked nurses to urge women to use techniques that assist natural birth, and hired laborists.
