SuppOrting vAginal delivery for low Risk mothers
SOAR is an initiative to reduce unnecessary cesarean delivery for low-risk, first-time mothers. The focus is on delivery of a nulliparous (first-time), singleton (single infant), term (> 37 weeks gestation) newborn in vertex (head-down) position, known as NTSV delivery.
“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
Why Is This Important?
Nearly 1 in 3 women who give birth in the United States does so by cesarean section. Cesarean birth can be life-saving for the fetus, the mother, or both in some cases. However, according to The American College of Obstetricians and Gynecologists (ACOG), there is no clear evidence that the high cesarean delivery rate has reduced maternal or neonatal morbidity or mortality, raising concern that cesareans are over-utilized. Unnecessary cesarean sections increase maternal morbidity and mortality and drive up health care costs.
Cesarean deliveries are associated with higher risk of maternal morbidity, including hemorrhage that requires hysterectomy or blood administration, uterine rupture, anesthesia complications, venous thromboembolism, infection, and wound disruption or hematoma. Infants born by cesarean are at greater risk for respiratory problems, antibiotic exposure and interference with maternal-child bonding.
At 21.4%, Colorado has a NTSV cesarean delivery rate that is better than the national average. But, there are broad differences in rates among Colorado hospitals, ranging from 7% to 45%.
The ultimate goal of this initiative is that all Colorado hospitals achieve the Healthy People national goal of 23.9% or less.
Partners & Participants
The following 6 hospitals are currently participating in the pilot project to reduce the NTSV cesarean delivery rate. Some of these hospitals already have low rates but want to improve even more.
- Lutheran Medical Center, Wheat Ridge
- Montrose Memorial Hospital, Montrose
- Rose Medical Center, Denver
- Saint Joseph Hospital, Denver
- St. Mary’s Medical Center, Grand Junction
- Vail Health, Vail
CPCQC is working with participating hospitals and their obstetrical providers to assure that the recommendations from ACOG and the Society for Maternal-Fetal Medicine (SMFM) are consistently practiced. To accomplish this, we are adapting and adopting tools from a toolkit developed by the California Maternal Quality Care Collaborative (CMQCC). CPCQC staff provides education, data and other resources to the participating hospitals.
Helpful Resources &
Want to learn more about safely reducing unnecessary cesarean deliveries? Check-out these tools and sites:
- Society for Maternal-Fetal Medicine “Safe Prevention of the Primary Cesarean Delivery” summary and slide set for professional education: https://www.smfm.org/publications/154-safe-prevention-of-the-primary-cesarean-delivery
- ACOG and SMFM Care Consensus: http://www.ajog.org/pb/assets/raw/Health%20Advance/journals/ymob/YMOB_Consensus.pdf
- California Maternal Quality Care Collaborative’s Toolkit to Support Vaginal Birth and Reduce Primary Cesareans, along with an Implementation Guide and slide set for professional education: https://www.cmqcc.org/VBirthToolkit
- ACOG Committee Opinion, “Cesarean Delivery on Maternal Request”: https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Cesarean-Delivery-on-Maternal-Request
- ACOG Committee Opinion, “Approaches to Limit Intervention During Labor and Birth”: https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Approaches-to-Limit-Intervention-During-Labor-and-Birth
- Washington State “Best Practice Recommendations for Labor and Delivery Care”: http://wsha.wpengine.com/wp-content/uploads/LaborMgmtBundle_09.26.16.pdf
- Washington State resources including Induction of Labor algorithm and checklist and Active/Spontaneous Labor algorithm and checklist: http://www.wsha.org/quality-safety/projects/safe-deliveries/labor-management/