Safely Reducing C-section Rates for Failure to Progress/Dystocia
Safely Reducing C-section Rates for Failure to Progress/Dystocia
The following recommendations are from a collaborative of the Institute for Healthcare Improvement in Boston:
1. Better practice
o Avoid unnecessary inductions:
— Inductions are done only for clear medical indications, such as post 42 weeks.
— Criteria for inductions are agreed upon and used by OB medical and nursing staff.
— Patients who do not enter labor after induction attempt are allowed to go home, unless some other reason forces more intervention.
o Sample targets:
— Primary C-section rate decreases by 30%.
— C-sections for FTP/Dystocia decrease by 50%.
— Decrease in C-sections following failed inductions by 75%.
2. Better practice
o No C-sections for FTP in latent phase of labor:
— Patients are not admitted for false labor, or before 3-4 cm dilation, unless they have a risk factor that necessitates admission.
— A triage capacity is available to assess and monitor patients prior to admission.
— OB staff use active labor management, including careful assessment of labor progress, use of oxytocin to augment labor, and guidelines to manage slow progress in the latent phase.
o Sample targets:
— C-sections for FTP in the latent phase decrease by 100%.
— Admission with cervical dilation less than 4 cm decrease by 75% in low-risk, nulliparous patients.
— Median cervical dilation on placement of epidural anesthesia to at least 4 cm.
3. Better practice
o Alleviate pain:
— Physicians offer adequate pain relief to patients.
— Nursing staff assess pain and provide a variety of pain relieving techniques (hydrotherapy, positioning).
— Epidurals are used judiciously, and placement is often delayed until 4 cm dilation. A walking epidural is available.
o Sample targets:
— Patients stating that their pain was the key factor in wanting a C-section decrease by 50%.
4. Better practice
o Support every patient in labor:
— Patients receive 1:1 labor support from nursing staff, doulas, or midwives.
— Patients are encouraged to ambulate and are given oral fluids during labor.
o Use patience:
— Allow patients in second stage of labor to "rest in descent," delaying pushing until the patient feels the urge to push.
— Eliminate arbitrary time deadlines for second stage of labor.
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