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 Cesarean Section: A Growing Focus of Maternity Care Quality Improvement

By Carol Sakala, PhD, MSPHSakala headshot.jpg
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:

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.