BOSTON — Even though nearly one in three infants born in the United States is delivered through cesarean section, the procedure is associated with increased health risks for mothers and babies — including higher death rates — as well as longer hospital stays and increased healthcare costs, compared to vaginal delivery.

So how did Beth Israel Deaconess Medical Center (BIDMC) significantly reduce its cesarean section rate over a seven-year period? A study published online by The Joint Commission Journal of Quality and Safety provides some answers.

Researchers focused on the effect a series of strategic quality improvement interventions on the hospital's nulliparous, term singleton vertex (NTSV) cesarean rate — i.e., the proportion of single babies carried to at least 37 weeks in the vertex position born to women having their first baby that were delivered via cesarean section.

"The rate of cesarean deliveries in low-risk women varies significantly from hospital to hospital across the nation, and such wide disparities suggest that some cesarean deliveries may be performed for reasons other than medical necessity," explained first author Mary A. Vadnais, MD, MPH, a maternal-fetal medicine specialist and vice chair of the Obstetrics Quality Assurance Committee at Beth Israel Deaconess. "Our research shows that quality improvement initiatives can significantly reduce cesarean deliveries in low-risk women, benefiting mothers and reducing healthcare costs."

The interventions, which began in 2008, were in the following five areas:

• interpretation and management of fetal heart rate tracings,
• provider tolerance for labor,
• induction of labor,
• provider awareness of NTSV cesarean delivery rates, and
• environmental stress.

Results indicate a reduction from 34.8% to 21% during the intervention period; the U.S. Department of Health and Human Service's recommended target rate is 23.9%. At the same time, the hospital’s overall cesarean rate dropped 40% to 29.1%.

"Since implementing these quality improvement measures, our department has seen a steady decline in our cesarean rate," pointed out senior author Toni Golen, MD, medical director of Labor and Delivery and Post-Partum. "More important, with that decline we have not seen a clinically significant rise in complications among babies or mothers, which demonstrates the success of the interventions."