Collaboration Leads to Reduction in Low-Risk, First-Birth C-sections
By Katarina Lannér-Cusin, M.D., administrative medical director, Women’s Services, Alta Bates Summit Medical Center
BERKELEY, Calif. – One of the advantages that an integrated healthcare delivery network like Sutter Health has is that its clinicians are able to improve quality by studying the experience and practice patterns of fellow clinicians. An example of this is our work to support vaginal delivery by reducing the rate of cesarean sections for low-risk, first-time births.
Sutter Health’s low-risk, first-birth C-section
rate is among the lowest in California, with nine
hospitals receiving recognition in 2017. Sutter’s average rate of 21.2 percent
is lower than the state’s Healthy People 2020 target of 23.9 percent and the 2016
California Maternity Quality Care Collaborative target of 22.2 percent.
Sutter’s integrated network enables sharing of best practices and real-time data for continual process and quality improvement, which allows the network to outperform state and national averages in many quality measures and improve outcomes for the communities it serves. Sutter hospitals are leaders in California in lowering C-section rates—notably low-risk, first-birth C-section rates.
Sutter is a member of the California Maternity Quality Care Collaborative (CMQCC), a multi-stakeholder organization committed to ending preventable morbidity, mortality and racial health disparities in California. Partnering with CMQCC and the California Health Care Foundation, Sutter is leading a labor culture campaign to proactively educate first-time mothers about C-sections and encourage them to engage with their care teams to support vaginal birth and avoid C-sections for low-risk pregnancies.
There are several key drivers that have been instrumental to achieve real progress in decreasing C-section rates in the Sutter network of care.
• The first and most important driver is effective communication and teamwork—a joint commitment by the clinical team (nurses, midwife and physician) to create a great supportive environment for patients.
• The second driver is alignment on best practices for labor support, including collaborative labor management and education. Sutter adopted a checklist in labor and delivery that establishes parameters clinicians need to complete before deciding on a C-section. The teams work collaboratively using the checklist to ensure that all best practices for supporting a vaginal birth have been implemented. Additionally, labor support education has been developed for nurses, midwives and physicians.
• The third driver is maternal agency—a birth preference sheet was created to educate new mothers about choices they make that may increase their likelihood of a vaginal delivery and give them the opportunity to talk with their physician or midwife about these choices before birth.
• Finally, a large component of lowering low-risk, first-time birth C-section rates is the open sharing of physician-level rates among peers. This transparency creates the opportunity for dialogue and shared learning among clinicians. Each group is encouraged to discuss these rates internally and come up with a plan to address any issues uncovered by the data.
Sutter Health is working to ensure that every patient receives the highest quality maternity care for herself and for her baby. For more information, please visit Pregnancy and Childbirth Services.