Affiliations

Advocate Good Samaritan Hospital

Presentation Notes

Quality Improvement poster presentation at Empowering Nursing Excellence: Recognizing the Value and Impact of Nurses, Advocate Health Midwest Region Nursing Research & Professional Development Conference 2023; November 15, 2023; virtual.

Abstract

Background

Over 90% of women whose first birth was by cesarean section will have a cesarean birth with future pregnancies. Cesarean births not only pose significant maternal and fetal risks for the current pregnancy but, for future pregnancies as well. A goal of Healthy People 2030 is to reduce cesarean births of low-risk (full term, singleton, vertex), nulliparous women to 23.6%.

Local Problem

The cesarean section delivery rate for nulliparous, term, singleton pregnancies (NTSV) at a suburban, Level 3 perinatal hospital was reported as a mean of 31.1% for the first 7 months of 2022 with an all-time high cesarean rate of 39.6% in July, 2022.

Methods

Using the plan-do-study-act methodology, a committee of obstetric nurses and obstetricians convened to address the low-risk, nulliparous cesarean rate. The committee recommended a multifaceted approach to promote vaginal delivery which included multidisciplinary education; procurement of positioning tools and visual aids; incorporation of standardized labor management guidelines, posting monthly and provider cesarean section rates, celebrating vaginal deliveries; physician and nurse case reviews of cesarean births; and the availability of champions. The cesarean rates were monitored post-implementation and compared to pre-implementation rates.

Results/Conclusions

The post-implementation cesarean section mean rate for low-risk, nulliparous women decreased to 25.9%. Although the cesarean section rate has not reached the goal of 23.6%, it is on a downward trend. Physician and nurse collaboration was key in promoting vaginal deliveries subsequently decreasing cesarean section births.

Implications for Practice

Physician and nurse collaboration is integral in decreasing the cesarean section rate for nulliparous, low-risk women.

Document Type

Poster

Publication Date

11-15-2023


 

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Nov 15th, 12:00 AM

Promoting vaginal birth - A collaborative approach

Background

Over 90% of women whose first birth was by cesarean section will have a cesarean birth with future pregnancies. Cesarean births not only pose significant maternal and fetal risks for the current pregnancy but, for future pregnancies as well. A goal of Healthy People 2030 is to reduce cesarean births of low-risk (full term, singleton, vertex), nulliparous women to 23.6%.

Local Problem

The cesarean section delivery rate for nulliparous, term, singleton pregnancies (NTSV) at a suburban, Level 3 perinatal hospital was reported as a mean of 31.1% for the first 7 months of 2022 with an all-time high cesarean rate of 39.6% in July, 2022.

Methods

Using the plan-do-study-act methodology, a committee of obstetric nurses and obstetricians convened to address the low-risk, nulliparous cesarean rate. The committee recommended a multifaceted approach to promote vaginal delivery which included multidisciplinary education; procurement of positioning tools and visual aids; incorporation of standardized labor management guidelines, posting monthly and provider cesarean section rates, celebrating vaginal deliveries; physician and nurse case reviews of cesarean births; and the availability of champions. The cesarean rates were monitored post-implementation and compared to pre-implementation rates.

Results/Conclusions

The post-implementation cesarean section mean rate for low-risk, nulliparous women decreased to 25.9%. Although the cesarean section rate has not reached the goal of 23.6%, it is on a downward trend. Physician and nurse collaboration was key in promoting vaginal deliveries subsequently decreasing cesarean section births.

Implications for Practice

Physician and nurse collaboration is integral in decreasing the cesarean section rate for nulliparous, low-risk women.

 

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