Is Proactive Management Contributing to an Increase in Cesarean Deliveries?

​The rate of cesarean delivery has jumped by 500% in the United States since the 1970s, according to a July 27, 2017, podcast at the Harvard School of Public Health's website. The rate of cesarean delivery varies between 7% and 70%, according to the article, and a labor and delivery unit's leadership culture may be the driving factor. The podcast presents an interview with the lead author of a study published in the August 2017 issue of Obstetrics & Gynecology. The study featured structured telephone interviews with primary nurse and physician managers at 53 hospitals across the United States. Their management approaches were classified by the authors as either proactive or reactive. For unit culture and nursing, proactive management was associated with a significantly higher risk of primary cesarean delivery among low-risk patients, as well as significantly higher risk for prolonged length of stay, postpartum hemorrhage, and blood transfusion. For case flow and nursing assignments, proactive management was associated with a lower risk of prolonged length of stay, the authors said, implying there is a potential opportunity to proactively improve labor and delivery efficiency.