Article Revised: March 28, 2019
A Boston hospital has decreased its cesarean delivery rate by 13 percent through a quality improvement initiative. According to a press release from The Joint Commission Journal on Quality and Patient Safety, a clinical instructor at Harvard School of Medicine teamed up with a maternal fetal medicine doctor from Beth Israel Deaconess Medical Center for a seven year study that produced five factors that may impact the cesarean delivery rate in women who are carrying one fetus, presenting in the head down position.
Women in this category are at lower risk for a cesarean than those carrying multiple fetuses or a fetus in the breach position, the release stated. The factors that cause cesareans in single, head-down presentations include the interpretation of fetal heart rate findings; the provider’s tolerance for labor, the induction of labor, the provider’s awareness of the cesarean rate for this category of patients; and environmental stress. After identifying these factors, the team spent seven years — from 2008-2015 — developing a multi-strategy approach that involved provider education as well as new policy that would reduce the number of cesarean deliveries.
Data was then collected regarding fetal, maternal, and neonatal outcomes from the births that were impacted by this new approach. Analysis was considered on more than 20,000 deliveries during the initiative, and the cesarean delivery rate for women in this category was reduced from 34.8 to 21.2 percent of the births. The total cesarean delivery rate for women at the hospital was reduced from 40 to 29.1 percent.
The study stressed the need for a cultural change in maternity units across the country to mitigate the recent rise in cesarean deliveries. It’s a change, the press release noted, that requires commitment and the willingness of hospitals to use multiple approaches in their quality improvement projects.
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