Can Quality Improvement Interventions Decrease Cesarean Delivery Rate?

​Quality improvement initiatives can lead to a significant decrease in nulliparous term singleton vertex (NTSV) cesarean delivery rate, according to a study published in the February 2017 Joint Commission Journal on Quality and Patient Safety. Compared with vaginal birth, cesarean delivery, which accounts for nearly one-third of births in the United States, is associated with increased morbidity and mortality. NTSV pregnancies have fewer risk factors for cesarean delivery than does the general obstetric population. The authors conducted their study between 2008 through 2015 at a single tertiary care academic medical center where the rate of NTSV cesarean delivery was higher than state and national averages. During the study period, rate of NTSV cesarean delivery decreased from 34.8% of all NTSV births to 21.2%. The overall cesarean-delivery rate also declined, from 40.0% to 29.1%. Before the study, the authors identified five factors (fetal heart rate tracing, tolerance of labor, induction of labor, environmental stress, and provider awareness) that contributed to the institution's high rate of NTSV cesarean delivery and addressed them with targeted interventions.