Online Program

Understanding the factors increasing cesarean delivery and impacting quality care

Sunday, November 3, 2013

Diana E. Ramos, MD, MPH, Reproductive Health, Maternal, Child & Adoloescent Health, Los Angeles County Department of Public Health, Los Angeles, CA
Giannina Donatoni, PhD, Maternal Child and Adolescent Health, Los Angeles County Public Health, Los Angeles, CA
Suzanne Bostwick, Maternal, Child, and Adolescent Health, Los Angeles County Department of Public Health, Los Angeles, CA
Cesarean Sections (c-sections) are the most common surgery in the U.S. In 2010, the national rate declined to 32.8% from 32.9% (2009). The Los Angeles County (LAC) rate increased to 37.7% from 37.2% (2009). Multiple reasons have been attributed for the increasing rate.

Methods: Obstetrician/gynecologists in LAC completed a self-administered questionnaire to assess their practices and attitudes related to c-sections.

Results: 117 obstetrician/gynecologists responded. The practice types were 37.4% (44/117) solo practice, 33% (39/117) group and 16.5% (19/117) university/teaching practices. Medicaid was the primary method of payment accepted, followed by private PPO, private HMO and other. Reasons cited for performing c-sections the month prior were failure to progress, fetal distress, failed induction, cephalo-pelvic disproportion and maternal complications (pre-eclampsia). 55% stated the threat of litigation drove them to recommend a cesarean delivery and 45% to discourage a VBAC. 53% stated their hospital c-section rate was too high. Although providers delivered at several hospitals, 98% of their primary affiliation had 24-hour in-house anesthesia. 95% stated they follow the ACOG recommendation of no elective delivery less than 39 weeks gestation. Email (85%) and medical conferences (33%) were the preferred methods of obtaining medical information.

Conclusion: The threat of litigation was cited as reason to perform a cesarean and not recommend a VBAC. In-house anesthesia was cited as important to have in their primary delivery hospital. ACOG practice recommendations were followed by participants. E-mail was the preferred method of obtaining medical information/recommendations. Patient quality of care and delivery of care is influenced by provider threat of litigation. A multi-pronged approach, working with providers, hospitals, malpractice companies and patients, is needed to address the most common cesarean section drivers.

Learning Areas:

Provision of health care to the public

Learning Objectives:
List the most common reasons for c-sections Describe the solutions to imporivng the qualilty of care in labor and delivery

Keyword(s): Perinatal Outcomes, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an ob/gyn, director for reproductive health with extensive experience in developing and implementing quality care programs.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.