Supporting Vaginal Delivery For Low Risk Mothers (SOAR)

What

The SOAR (SuppOrting vAginal delivery for low-Risk mothers) Learning Collaborative is a ground-breaking program aimed at standardizing care excellence across Colorado hospitals. 

Nulliparous, term, singleton, vertex (NTSV) births include live babies born at or beyond 37 weeks gestation to birthing people in their first pregnancy that are singleton (no twins or beyond) and in the vertex presentation (no breech or transverse positions). This group was identified as the key population of focus to reduce unnecessary cesarean deliveries due to it being the least risky population giving birth and a population that carries an increased burden of risk through the remainder of their reproductive years.

Our mission is clear: achieve and maintain the Healthy People 2030 cesarean target rate for low-risk birthing people of 23.6%, making Colorado one of the safest places to birth in America.

Why

While cesarean deliveries can be lifesaving, there is no evidence that the high instance of cesareans in the United States (1 in 3 births) reduces infant or maternal morbidity and mortality. On the contrary, evidence shows cesarean sections are overused, putting some birthing people and infants at needless risk. Unnecessary cesareans increase maternal mortality and morbidity rates. According to the Colorado Maternal Mortality Review Committee, cesarean sections contributed to 20% of pregnancy-related deaths from 2017-2020. Vaginal births, by contrast, have healthier outcomes for birthing people and babies and lower costs for hospitals and birth centers. Though Colorado’s overall cesarean delivery rate (27.2%) is below the national average (32.1%), rates vary greatly among providers and facilities from 7% to 45%. Where a person chooses to give birth impacts their likelihood of having a Cesarean birth. The hospital itself is considered an independent risk factor for a cesarean birth.

Equally alarming, these Cesarean births are not distributed equally among populations. Racial disparities present a grim picture, with the CDC reporting that Black birthing people are more likely to undergo a Cesarean and significantly more likely to die from pregnancy-related causes compared to their White counterparts. 

Additional benefits of cesarean reduction:

  • Decreasing primary cesarean sections positions your hospital to benefit from state incentive programs and national accreditation.
  • Reducing primary cesarean rates decreases patient readmission and hospital stays, alleviating staffing burden, staff workload, and reducing the risk of burnout.
  • Lowering cesarean rates cuts costs associated with extended hospital stays for the birthing person and newborn.
  • Reducing cesarean rates contributes to the sustainability of the healthcare system and ensures the efficient use of Medicaid funds. 

Our Goal

The SOAR Learning Collaborative aims to create consistency among Colorado hospitals and birth centers to help them achieve and maintain the Healthy People 2020 cesarean target rate of 23.6%. 

We aim to reach 100% of birthing hospitals and make Colorado one of the safest places to birth in America. 

How

CPCQC leads hospitals in implementing the Safe Reduction of Primary Cesarean Birth AIM Patient Safety Bundle. To do this, CPCQC facilitates a free collaborative learning environment for participating birth facilities to foster partnerships and accelerate quality improvement. Research shows that educational experiences that are active, social, contextual, engaging, and learner-owned. Learning collaboratives:

  • Create opportunities to build and exchange knowledge on measure testing, implementation, and data collection.
  • Disseminate information gained from the implementation of quality improvement.
  • Provide a forum to share successes and challenges to build capacity and sustainability for improved patient care and outcomes.

Each hospital in Colorado faces both universal and unique challenges when approaching quality improvement. In 2024, CPCQC is offering a 2-track model to tailor our support to hospital needs. Participation in both of these models is a 1-year commitment beginning January 2024. Our goal is to offer hospitals the support needed to sustain care delivery and outcome improvements beyond participation in our programming.

Track 1: Learning Collaborative

Hospitals that have not achieved and maintained an average NTSV Cesarean rate at or below the Healthy People 2030 goal of 23.6% are enrolled in the Learning Collaborative. This Collaborative offers:

  • quarterly 1:1 quality improvement coaching,
  • monthly data collection and feedback, and 
  • an opportunity to learn from peer hospitals during monthly collaborative learning sessions.

Track 2: Sustainability Cohort

Hospitals that have achieved and maintained an average NTSV Cesarean rate at or below the Healthy People 2030 goal of 23.6% are enrolled in the Sustainability Cohort. This Cohort offers:

  • twice-a-year 1:1 quality improvement coaching
  • quarterly data feedback, and 
  • an opportunity to learn from peer hospitals during quarterly collaborative learning sessions.

Learn more

Community Impact

  • SOAR participating hospitals account for approximately 40% of Colorado births. 
  • In the last year, participating SOAR hospitals averaged an NTSV Cesarean birth rate of 24.5% compared to the national average of 25.9%.
Elizabeth McDaniel smiling at the camera

“I am so proud of the work our physicians and nurses at Vail Health are doing as we participate in SOAR. Being a part of this project with other Colorado hospitals has given us the support and spirit to invigorate the work we do at Vail Health. For the past three months, the cesarean rate for our first-time, low-risk mothers has been below 13%. We are making a significant difference in the lives of families in our community, helping to prevent maternal morbidity and mortality.”

—Elizabeth McDaniel, BSN, CNML, RNC-OB, Clinical Nurse Manager, Family Birth Center, Vail Health Hospital

Learn More About Participating in SOAR

Any Colorado hospital labor and delivery unit is eligible to participate in SOAR.

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