July 21st, 2018

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A Multi-Strategy Approach for Cesarean Section Reduction at an Urban Community Medical Center
Authors:  Iffath Abbasi Hoskins, M.D., Thomasena Ellison, M.D., and Ralph Ruggiero, M.D.
  OBJECTIVE: To develop a multi-strategy approach to reduce the cesarean section (C/S) rate at a community hospital serving a multiethnic patient population.

STUDY DESIGN: A combination of antepartum and intrapartum strategies to re-
duce C/S were created and implemented over a period of 10 months. These were applied as clinically indicated for every patient who was being considered for undergoing a primary C/S or an elective repeat C/S. The resulting total C/S rate was retrospectively compared with the total C/S rate of a cohort of patients within the same department who underwent C/S prior to the implementation of these strategies.

RESULTS: In the period prior to implementing the strategies, there were 3,566 deliveries and a total C/S rate of 39% versus 3,425 deliveries and a total C/S rate of 29% in the study period. This was statistically significant (p<0.05).

CONCLUSION: Implementing a combined approach of strategies that addressed the issues both in the antepartum and the intrapartum periods resulted in a significant decrease in the total C/S rate. This was accomplished by getting greater buy-in from the providers and also by formally including the patients into the decision-making process. Of note, these results were achieved without any compromise to the safety and quality of patient care in the department.
Keywords:  C-section (OB); caesarean section; cesarean section; cesarean section rate, cesarean section reduction; delivery, abdominal; repeat cesarean section; vaginal birth after cesarean; VBAC
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