By Carol Sakala, PhD, MSPH
Director of Childbirth Connection Programs, National Partnership for Women & Families
The "Elective Delivery" performance measure was developed to encourage U.S. hospitals to eliminate virtually all scheduled births without indication before 39 weeks' gestation. There are important opportunities for improvement, and a new Playbook for Successful Elimination of Early Elective Deliveries points the way forward. Overall, however, the maternity care community has made exceptional progress on this measure, which gave many in the field experience working on quality improvement. Many groups are turning to a new quality improvement challenge, the overuse of cesarean section in U.S. hospitals.
As currently proposed, in 2015, Title V will require states to select and report on eight of 15 National Performance Measures, including cesarean section. This article briefly describes this measure and identifies resources to support more appropriate use of cesarean section from Childbirth Connection Programs at the National Partnership for Women & Families.
The cesarean section measure is not the total cesarean rate, but rather a risk-stratified cesarean rate in low-risk first birth women. Its "nickname" is NTSV: referring to a denominator limited to nulliparous women at term with a singleton baby in vertex (head-first) position. This group is a focus as first-time mothers with a vaginal births have a low likelihood of a cesarean in future births. This measure is endorsed by the National Quality Forum, one of five measures in The Joint Commission Perinatal Care core set, and a part of the Medicaid and the Children's Health Insurance Program (CHIP) core set of Children's Health Care Quality Measures.
Childbirth Connection has been concerned about overuse of cesarean section for more than a decade and has developed numerous resources to help women and professionals understand use of this procedure and avoid unneeded cesareans.
Childbirth Connection provides the following for childbearing women:
The following more technical resources are suitable for health professionals and others:
- Trend graph and table, Rates for Total Cesarean Section, Primary Cesarean Section, and Vaginal Birth After Cesarean (VBAC): United States, 1989-2012 (available as PDF and Web page)
- Article separating fact from fiction, "Why is the National U.S. Cesarean Section Rate So High?" (available as PDF and Web page)
- Results from national survey of childbearing women, What Are Some Factors Driving the Use of Cesarean Section in the United States: A Listening to Mothers III Data Brief (available as PDF and Web page)
- Fact sheet on role of liability in mode of birth, from liability report, 4. Defensive Practice in Maternity Care (available as PDF and Web page)
- Updated review of differences in outcome by mode of birth, Vaginal or Cesarean Birth: What Is at Stake for Women and Babies; A Best Evidence Review (PDF)
- Detailed report of actual payments for maternal-newborn care, with breakdown by mode of birth, The Cost of Having A Baby in the United States (PDF)
- Cross-national comparisons from International Federation of Health Plans, Average Maternity Services Payments, United States and Other Countries, 2012 (PDF)
Many evidence-based practices can help drive improved performance on the cesarean section measure, with important short- and longer-term health benefits for women and babies and health system cost savings.