cesarean sectionIn recent years C-section rates have increased significantly. Many of the C-sections performed are elective and some are performed during the 37th and 38th week of gestation. Recent changes in hospital quality improvement programs in 25 hospitals aimed at reducing elective C-section rates using a one-year program. C-section rates dropped 83%.

The study, which was partially funded by the March of Dimes, was designed to test the efficacy of a relatively short-term program of just one year. Participating hospitals were given access to the Elimination of Non-Medically Indicative Deliveries toolkit. The toolkit outlined changes hospitals should make in elective C-section protocols to reduce the number of premature deliveries and elective deliveries prior to the 39th week of pregnancy.

After implementing the changes outlined in the toolkit, the participating hospitals reported elective C-section rates dropping from 27.8% to a mere 4.8% after just one year. The five states targeted for the study were Illinois, Florida, New York, Texas and California. The states were not part of a random selection process. These five states account for nearly 40% of all births in the United States.

With the reduction in early elective C-section rates came a concurrent increase in delivery rates between 39 and 41 weeks gestation. The last few weeks of gestation are crucial for the development of organ systems and lungs in preparation for life outside the womb. While medical technology and advancements have reduced the number of deaths associated with premature birth, health risks still exist and can plague premature infants well into adulthood. Decreasing elective C-sections prior to the 39th week gestation is a step in the right direction to reduce medical costs associated with premature delivery and increase the quality of life for infants allowed to stay in utero just a little bit longer.

There is no mention by the study authors of a long-term study examining the elective C-section rates in the same hospitals at the five or ten-year mark. There is also no mention of expanding the program to other hospitals in less populous states in hopes of reproducing the same elective C-section reduction.

Source: Bryan T. Oshiro, Leslie Kowalewski, William Sappenfield, Caroline C. Alter, Vani R. Bettegowda, Rebecca Russell, John Curran, Lori Reeves, Marilyn Kacica, Nelson Andino, Peyton Mason-Marti, Dennis Crouse, Susan Knight, Karen Littlejohn, Sharyn Malatok, Donald J. Dudley, Scott D. Berns. A Multistate Quality Improvement Program to Decrease Elective Deliveries Before 39 Weeks of Gestation. Obstetrics & Gynecology, 2013; DOI: 10.1097/AOG.0b013e31828ca096.