Decreasing the cesarean section rate in Los Angeles County (LAC)

BACKGROUND Los Angeles County, with over 150,000 deliveries annually, has a 37% c-section rate, the highest in California and well above the 32% national average in 2008. Information on drivers for c-section are limited to vital records and ICD-9 discharge code studies. METHODS A three pronged approach focusing on hospitals, providers and patient education was developed. A total of 3,500 c-section and matched vaginal delivery charts from LAC's highest primary c-section hospitals, analyzing factors not typically captured by vital records and ICD-9 codes, was conducted. An obstetrics provider survey to understand reasons and motivators for performing c-sections was disseminated throughout LAC. A focus group on a patient education brochure about the risks of- and preventive strategies for- c-section was produced. RESULTS Initial chart review demonstrates discordance between ICD-9 codes and charted indicators for primary c-sections. Preliminary provider survey results demonstrate that respondents believe c-section rates in their hospitals are too high and that the threat of litigation is a major driver for c-sections. Feedback from the consumer focus group highlighted that not enough education is being provided to women about risk factors for c-section and interventions to prevent a c-section. DISCUSSION Results from a concerted effort to understand c-section drivers from a hospital, provider and consumer perspective will be used by LAC to develop initiatives to reduce the c-section rate. Obstetric providers, obstetric payers, hospitals and consumers will be critical in addressing the c-section rate.