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Reductions in Cesarean Rates for Low-Risk Patients

Written by cpcqc on . Posted in News.

How CPCQC is Responding to Rising Cesarean Rates

In 2024, the Colorado Perinatal Care Quality Collaborative (CPCQC) innovatively revamped its SOAR Primary Cesarean Reduction program into a one-year, intensive learning collaborative. This decision comes in response to a concerning trend observed since 2016: a steady increase in Cesarean rates among low-risk birthing individuals in Colorado, alongside growing disparities in Cesarean rates across different hospitals and providers.

Mobilizing Hospitals for Change: A Collaborative Approach to Cesarean Reduction

To address this issue head-on, our team successfully enlisted 23 birthing hospitals across Colorado, representing 40% of the state’s births, to join this year-long initiative. This collaborative is dedicated to tackling both systemic and direct factors contributing to unnecessary Cesarean deliveries. On February 9th, CPCQC organized an in-person forum at St. Joe’s Hospital for the participating hospitals. This event featured a virtual keynote speech by Dr. Neel Shah and concentrated on broad strategies for promoting safe vaginal births. Discussions covered the adoption of state-based quality measures, the expansion of the midwifery workforce in rural areas, and the integration of doulas to provide continuous support to birthing individuals.

Shifting the Curve to Reduce Maternal Mortality

Written by cpcqc on . Posted in News.

We are awaiting the anticipated release of data and recommendations from Colorado’s Maternal Mortality Review Committee (MMRC) on pregnancy-associated and pregnancy-related deaths. However, from previously released reports and national trends, we have an idea of what the data will show.

We have only seen an increase in maternal mortality rates in the United States since the CDC first implemented the Pregnancy Mortality Surveillance System in 1986.

  • From 7.2 deaths per 100,000 live births in 1987 to
  • 17.2 deaths per 100,000 live births in 2015 to
  • 32.9 deaths per 100,000 live births in 2021

These grim statistics are desperately headed in the wrong direction, especially for Black and Native American moms and birthing people.

Looking at 2022 data from the Colorado Hospital Association, Black moms are 53% more likely to experience severe maternal morbidity—such as heart failure, eclampsia, hysterectomy, and blood infection or need for blood transfusion—than their white counterparts which is only surpassed by Native American mothers who are twice as likely (98%) as their white counterparts. Alongside these disparities, In Colorado, 39.7% of counties are maternity care deserts. Maternity care deserts are counties in which access to maternity health care services is limited or absent, either through lack of services or barriers to a woman’s ability to access that care within counties.

And we would be remiss not to mention the Supreme Court Dodd Decision which changed the landscape of perinatal health and maternal/fetal medicine with long-lasting, and increasingly alarming national reverberations.

We do not intend to sit idly by with this data. Because these are not just “data.” These statistics represent the people who have influenced and nurtured us, our mothers and grandmothers and parents—humans. These numbers are not just an episode of care or a bundled payment, they represent someone’s body, someone’s emotions and experiences. There is a level of anonymity in talking about data that makes it seem like it isn’t personal, that it is a thing without an owner, without a cause, without an opportunity. But, it isn’t. We have heard from many voices that are the lived experience of some of this data.

The Colorado Perinatal Care Quality Collaborative began operating 47 years ago in recognition of the fact that quality improvement doesn’t just happen. It is a deliberate process of assessment, evidence gathering, intervention, review, and realignment…and repetition. It requires commitment, it requires funding, and it requires a growth mindset – aligned with incentives.

We acknowledge that health systems, hospitals, and clinics are one piece in supporting a change in the trajectory of maternal health and outcomes across Colorado. However, medical care is only part of a large, dynamic array of factors that influence pregnancy, birth, and the start of a new family. It is important that we consider all the complexity and the social and structural factors that contribute in large part to where we are today.  It will take strong leadership and partnership to realize our vision: that EVERY pregnant and postpartum person, infant, and their families in Colorado have access to and receive safe, equitable, high-quality care.

Racial Disparities in Colorado Maternal Outcomes: A Call to Action

Written by cpcqc on . Posted in News.

By CPCQC and the Colorado NAACP

Recent data shows sobering statistics of increased rates of maternal mortality and persisting racial disparities nationwide. This data reminds us that we have so much more work to do to improve equity to access and care for moms, birthing people, and their babies across our country and in our state. CPCQC is coming to the table with the NAACP to talk about maternal health and to find new ways to connect and align our work in ending racial disparities in maternal and infant health outcomes.

The data has also given us more insight into the depth of the disparities in maternal health outcomes across communities of color in Colorado. Given so many have come together across our state to make meaningful change, sometimes disheartening data, such as this, can be hard to accept. However, we can and we must accept what the data tells us and use it to continue to improve how we care for all moms, birthing people, and their babies throughout the perinatal period.

This week we anticipate the release of the Colorado Department of Health Care Policy and Financing’s Maternal Health Equity report and all that it will reveal on the health and well-being of Black mothers and birthing people in Colorado who are covered under public health insurance for maternity care. However, we know that much of what the CDC reports on racial disparities in maternal outcomes nationally is also playing out in Colorado. And, new data from the Colorado Department of Public Health and Environment reports that Maternal Mortality Review Commission (MMRC) data between 2014–2018 showed that the pregnancy-associated mortality ratio was disproportionately high for Native Americans in Colorado (233.4 compared to the average of 46.6), and the pregnancy-related mortality ratio for Black Coloradans was significantly higher than the average (52.0 compared to 19.7). Starting with maternal deaths in 2017,  the MMRC assessed whether discrimination—through implicit bias, structural racism, or interpersonal racism—was a contributing factor. To date, it has been found that discrimination contributed to 39.6% of all maternal deaths. A 2019 Medicaid report also showed that Native American and Black patients were less likely to receive timely prenatal care (72.1% and 73.0% respectively, compared to 77.1% of all Medicaid patients).

Using newly analyzed discharge data provided by Colorado Hospital Association for 2022, Black mothers are 53% more likely to experience SMM than their white counterparts which is only surpassed by Native American mothers who are twice as likely (98%). Hispanic mothers are 28% more likely to experience severe maternal morbidity and Asian mothers – 20% more likely.

Severe maternal morbidity (SMM) is a measure of unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a birthing person’s health. While maternal mortality rates reflect the worst possible outcome of a pregnancy, because SMM includes patients whose health was severely impacted by birth but did not die as a result of their pregnancy, SMM rates reflect negative outcomes that occur in a larger population of patients, and include “near-misses.”