August 31, 2015

Washington state's cesarean section rates declining

Cesarean section (C-section) rates are at their lowest levels since 2003, according to the Washington State Hospital Association (WSHA) and Washington State Health Care Authority (HCA). Between 2010-2014, Washington state had an 11 percent reduction in C-sections for low-risk, first-birth pregnancies.

“This is great news for Washington state families,” said Carol Wagner, RN, WSHA’s Senior Vice President for Patient Safety. “The declining rate means fewer potential health complications for both babies and mothers.”

First-time C-sections are at their lowest rate since 2003, and already below the 2016 statewide goal of 14.7 percent. Many stakeholders, including HCA, WSHA, the Robert Bree Collaborative, the Foundation for Health Care Quality, Washington State Perinatal Collaborative, the Department of Health and the Department of Social and Health Services, have worked collaboratively for several years to identify best practices, analyze data and provide information to help providers improve the quality and cost-effectiveness of maternity care.

“We are glad to see these rates going down,” Wagner said. “Washington state already has C-section rates that are lower than many parts of the country, but we believe we might be able to optimize the outcomes for both mother and baby even more by improving care throughout pregnancy. But that work doesn’t happen in isolation: hospitals, physicians, nurses and patients need to continue to work together. C-section rates are an important part of the work we’re doing with Results Washington, and that keeps our eyes on the ball.”

“In recent years, new knowledge has been published that indicates the C-section rate might be safely reduced by following new guidelines,” said Thomas Benedetti, MD and Dale Reisner, MD. Benedetti and Reisner are two of the physician leaders on WSHA’s Safe Delivery Roadmap project, which is designed to identify and spread evidence-based best practices related to pre-pregnancy, pregnancy, delivery and post-delivery care. “We need to continue to closely monitor both maternal and baby health to be sure there are no unintended consequences associated with lowering C-section rates and we have a mechanism set up to do that,” Benedetti and Reisner said.

“The declining rate of C-sections shows that when we as a state combine the power of collaboration, shared vision and data, we can get this kind of progress,” HCA Chief Medical Officer Dr. Dan Lessler said.

Why are C-section rates important?

Cesarean delivery is associated with higher rates of mother and baby complications. Part of the increase in cesarean delivery rates has undoubtedly been due to a changing population of pregnant patients. Women of childbearing age now may be older, heavier and have more medical complications entering pregnancy than women in past decades. All these factors are known to increase the cesarean section rate. However, these factors do not explain all the increase in cesarean section rates and recent efforts in Washington state and nationally have been to reduce the hospital-to-hospital variation.
Washington state’s efforts to optimize C-section rates and other maternal health outcomes
An increasing body of research shows that there are short and long term hazards of delivery prior to 39 weeks, when there aren’t other medical complications. Those last several weeks of gestation gives babies needed time to mature. For example, babies that are allowed to mature before being delivered have lungs and brains that are more developed. Experts on the data trends are available for interview. Efforts to allow babies to mature have been successful and have impacted cesarean section rates in Washington state.
In 2013, WSHA spearheaded further collaborative efforts to reduce the unexplained variation in C-sections through a partnership with HCA, DOH, WSMA, ACOG, the Foundation for Health Care Quality and the Washington State Association of Obstetrics (WSOA). The “Safe Deliveries Roadmap” works with national and local experts, and draws upon the recommendations of the Bree Collaborative, to implement a comprehensive Roadmap that includes evidence-based practices from pre-pregnancy to a month after birth to ensure babies get the healthiest, best start possible. Washington is the first in the country to adopt such a comprehensive approach.
An introduction to the project and a video can be found at
The groundwork for this progress was laid by the Washington State Perinatal Collaborative, which was fueled by partnerships with WSHA, the March of Dimes, the American College of Obstetricians and Gynecologists and the Washington State Department of Health.
Other organizations working to drive forward improvements in the health of mothers and babies are the Bree Collaborative and the Foundation for Health Care Quality.

What does the data say?
Washington state has some of the best perinatal quality outcomes in the country. As a result of collaboration by the many partners, rates of elective delivery before 39 weeks and elective episiotomy have dramatically improved over the last several years. The improving C-section rate, already in the best third in the country, is indicating that further improvements can be made to help babies develop longer in the womb.

Collaborative initiative involving hospitals has helped lead statewide effort to reduce C-section rates 
Source: Cawthon, L. Delivery Statistics Report (2014 Births) Washington State Non-Military Hospitals, Department of Social and Health Services Research and Data Analysis Division, March 30, 2015.

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