Improving Maternity Care in Michigan by Safely Reducing Low-Risk C-Sections
Cesarean delivery rates have been increasing in the United States since the 1970s and today, one in three births are by C-section. Often, a cesarean delivery is necessary for the life or health of the baby or mother.
But cesarean deliveries also carry risks. They are associated with an increased risk of hemorrhage, hysterectomy, infection and other complications for both mother and infant. Cesarean sections also cost 50% more than a standard vaginal delivery. And evidence suggests, some cesareans are not medically necessary.
That’s why Blue Cross and 73 hospitals across Michigan have launched an initiative to safely reduce non-medically necessary, low-risk cesarean deliveries statewide. A low-risk delivery is typically one where the baby is at term (at least 37 weeks), a singleton (one baby, not twins or multiples), in a head-down position, and it’s the mother’s first time delivering. To date, Michigan has a higher rate of low-risk C-sections than the national average.
There is great variation in cesarean delivery throughout the state. The goal is to learn why some areas of the state have rates as high as 44% while others are only at 9%. Nearly all the maternity hospitals in Michigan are working together to gather and analyze data to find the best ways to reduce low-risk C-sections that are medically unnecessary.
The initiative collects a rich amount of data from multiple sources including the participating hospitals, Blue Cross, and state birth certificate data, all to help shed light on situations that lead to a C-section. A coordinating center at the University of Michigan manages the data. The coordinating center, in collaboration with the participating hospital, will work together to examine the data and identify opportunities for improvement.
For example, project participants looked at research that showed women who are admitted to the hospital during the early stages of labor have a significantly higher risk of delivering by cesarean than women who are admitted during active labor.
They then developed an admission checklist that labor and delivery triage staff can use to assess patient readiness for admission. This tool promotes shared decision making between the hospital team and the patient. Not being admitted during this phase of labor has been linked to reduced cesarean deliveries, reduced use of epidurals, and lower rates of maternal death.
“Hospital staff are using the checklist to help them identify who could spend this labor period outside of the hospital and helps them work together with the mother to provide appropriate support,” said Daniel Morgan, MD, program director. “So, mothers-to-be know what to expect and what to look for and work together with the maternity team to be safely admitted when they reach active labor, or before that if the maternity team thinks it’s best.”
If you enjoyed this post, you might also like:
About the author: Faris Ahmad, MD is a medical director at Blue Cross Blue Shield of Michigan. For more information, go to obstetricsinitiative.org.
Photo credit: FatCamera