Healthcare News & Insights

C-sections: Reducing rates, improving outcomes

C-section rates are consistently high for American mothers, and groups like the World Health Organization (WHO) have tasked hospitals with keeping expectant mothers safe. Various interventions can be effective in reducing the rates of C-sections and minimizing complications for mothers who do have them. 

Research from Beth Israel Deaconess Medical Center showed that hospital-led interventions designed to lower C-section rates had a significant impact.

According to a press release, the results of the study were published online in The Joint Commission Journal of Quality and Safety.

Targeted interventions

C-sections shouldn’t be performed unless babies and mothers are in danger, but the frequency of the surgery in hospitals across the nation suggest they occur without medical necessity in many cases. Almost one in three births in the country happen via C-section, according to the Centers for Disease Control and Prevention (CDC) – far from suggested rates from WHO, the Department of Health and Human Services (HHS) and other agencies.

To tackle this problem, Beth Israel created targeted initiatives to make improvements in five areas that affect C-section rates: interpretation and management of fetal heart rate tracings, provider awareness of C-section delivery rates, provider tolerance for labor, environmental stress and induction of labor.

In each area, the hospital took specific steps to decrease the number of C-sections performed on expectant mothers.

Example: Providers traditionally recommend C-sections if labor is progressing slowly. However, the “normal” time for labor varies greatly, so labor for some women may naturally be slower than others. So the hospital encouraged providers to reassess how they approach slower labors and commit to avoiding C-sections whenever possible unless other risk factors are present.

Beth Israel’s interventions made a significant impact on the hospital’s C-section rates. Rates fell from 34.8% in 2008 to 21.2% in 2016, which is below HHS’s recommendation of 23.9%.

App helps with recovery

For mothers who must have C-sections, it’s important to make sure they don’t experience any complications during and after delivery. To meet this goal, hospitals need to get mothers engaged in the recovery process, starting before the surgery even happens.

In one research study, the use of a smartphone app helped improve outcomes for expectant mothers scheduled to receive C-sections.

As detailed in a news release, the mothers were participants in a perioperative surgical home program, which is a patient-centered, team-based model that’s designed for better coordination of care.

Each mother was required to download an app that reminded them about appointments and pre-surgery care, gave them information about medications and recovery, and provided instructions about how to assess their health after the surgery (using metrics like wound recovery and pain control).

Among the first women who used the app, the average length of stay immediately after their C-sections was 2.7 days. The average length of stay for other mothers who had C-sections was 3.7 days. Plus, early results are showing a positive impact on urinary tract infections, surgical site infections and patient satisfaction.

Through the app, patients receive information to help them be active participants in their recovery, which is a crucial element of providing quality health care. Finding similar strategies that improve outcomes while lowering costs should be a priority for all hospitals – especially if payments for maternity care become bundled down the line.

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