Reducing C-sections can decrease risks of fetal and maternal harm. In 2020 The C-section rate at Rush University Medical Center was 33%, which was above the Healthy People 2020 goal of 24.7%. A program was developed to decrease the percentage of patients having C-section deliveries and improve care and outcomes for our patients.
In January 2021, health care providers in the labor and delivery unit formed a team to analyze the increased C-section rates and develop an action plan for improvement.
The team, named Promoting Vaginal Births, was led by Christin Scott, BSN, RN, C-EFM (RN3); Melissa Holland, MSN, RNC-OB, C-EFM, CNL, CPPS (Perinatal Safety Nurse); Kalah Bermudez RN, C-EFM; Sophie Maynard, BSN, RN, DNP, C-EFM; Maggie Quinn, MSN, RN, C-EFM; Iheoma Nkemere, MSN, RN, C-EFM; Emma Martinez, MSN, RN, C-EFM; Olivia Bouchard, RN, MSN, C-EFM; Martha Curiel, APN; Lindsey Heffron, BSN, RN, C-EFM; Robin Drake, MD; Stacey Sudholt, MD; Laura Laursen, MD; and Baillie Bronner, MD.
The team’s objectives were the following:
- Optimize health outcomes
- Decrease the percentage of women who have C-section deliveries
- Increase the percentage of providers, midwives and nurses trained on the American College of Obstetricians and Gynecologists and Society for Maternal-Fetal Medicine guidelines for C-section labor management strategies, response to labor challenges and protocols for facilitating decision-making huddles
Promoting Vaginal Births was led by nursing to improve the care of laboring women which included: researching best practices, implementing huddles, education and grand rounds, sharing C-section rates for nurses and physicians, and creating patient information packets on laboring.
Education focused on a review of the anatomy and physiology of labor, intentional positioning of patients and pain management techniques. In March 2023, coping in labor assessments replaced traditional pain assessments for laboring patients. A QR code, providing guidance on intentional labor positioning and positioning for labor dystocia, went live.
Obstetric (OB) informational packets were created and provided to patients in OB triage and in the office setting. The goal of the packets was to provide enough information that patients felt comfortable laboring at home for a period of time, which is an evidence-based practice technique to decrease C-section rates.
Promoting Vaginal Births has been an effective strategy for improving patient outcomes. The overall C-section rate decreased from 33% in December 2020 to 25% in January through June 2023.
It is notable to report that at the end of 2020, Black patients had a 40% C-section rate as compared to a 26% rate for white patients. In the first two quarters of 2023, Black patients saw a 19% reduction in C-section rate at 21% as compared to white patient’s C-section rate of 24%. The rate for patients who identified as Asian had a 31% C-section rate at end of 2020 that dropped to 11% in 2023.