Multiyear Initiative Lowers C-Section Rate, Safely and Successfully

Cesarean deliveries can save mothers’ and babies’ lives. Yet they also are associated with risks, such as increased rates of maternal hemorrhage and infection, and increased chances of neonatal transition difficulties. Even when all goes well, a surgical delivery means a slower recovery for new mothers. Consequently, reducing unnecessary C-sections is a high priority in obstetrics.

“In mid-2020, we launched an initiative at Lehigh Valley Health Network (LVHN) aimed at safely decreasing our C-section rates,” says Travis Dayon, MD, Chief of the Division of Obstetrics. “The latest data shows that we are not only performing significantly fewer C-sections now but also maintaining a high level of safety.”

Some hospitals take care of more high-risk obstetric individuals and very preterm babies than others. As a result, simply comparing overall C-section rates can be misleading. One solution is to analyze data from a standardized lower-risk population identified by the acronym NTSVL – short for nulliparous, term, singleton, vertex, living births. At LVHN, the most recent data shows a substantial drop in C-sections for NTSVL births.

To watch for any signs of safety issues, the initiative also monitored balancing metrics, such as poor Apgar scores, unexpected NICU admissions and maternal trauma. “During this same time period, the counter metrics stayed the same or, in many cases, actually improved,” Dayon says. 

This impressive success was a group effort. “The first step was gathering accurate data from electronic medical records,” Dayon says. “We worked closely with the network data team to build a dashboard, which continues to be updated monthly. It breaks down C-section rates campus by campus and physician by physician.”

The next step was raising awareness and sharing information through forums for attending physicians, residents, staff nurses and nursing leadership. The formats ranged from large-group grand rounds to small-group workshops. Sample topics included how long induced labor can safely continue and which positional changes may potentially reduce delayed or obstructed labor.

“At this point, awareness of C-section issues has become more ingrained in our LVHN culture,” Dayon says. “Physicians can still access their individual data on the dashboard. Nothing has changed about how much each of our doctors puts into patient care every day. What has really helped is having objective data to guide them.”