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July – August 2019
A message from Faris Ahmad, M.D., M.B.A., medical director
Obstetrics Initiative works to improve maternity care by safely reducing low-risk cesarean sections
 Cesarean delivery rates have been increasing in the United States since the 1970s. Today, nearly 1 in 3 births are by cesarean section, according to the Centers for Disease Control and Prevention.
Often a cesarean delivery is necessary for the life or health of the baby or mother, but this type of delivery also carries risks. Cesarean deliveries are associated with multiple complications for the mother, including infection and hemorrhage, as well as complications for the infant, such as respiratory difficulties.
Evidence suggests that some cesareans, especially in women who are at lower risk, can be avoided.
That’s why Blue Cross Blue Shield of Michigan and 73 hospitals across Michigan have launched the Obstetrics Initiative, a new Collaborative Quality Initiative. The program aims to safely reduce non-medically necessary, low-risk cesarean deliveries statewide.
A low-risk delivery is typically one where it’s the mother’s first delivery and the baby is:
- At term (at least 37 weeks)
- A
singleton (one baby, not twins or multiples)
- In a head-down position
Interestingly, Michigan has a higher rate of low-risk cesarean sections than the national average. There’s great variation in cesarean delivery throughout the state.
We need to find out why some areas of the state have rates as high as 44% while others are only at 9%. We’re working together with nearly all the maternity hospitals in the state to gather and analyze data to find the best ways to reduce low-risk cesarean sections that are medically unnecessary.
The initiative is collecting a vast amount of data from multiple sources — including the participating hospitals, Blue Cross and state birth certificate data — to help shed light on what type of situations that lead to a cesarean section. A coordinating center at the University of Michigan manages the data. The center, in collaboration with participating hospitals, will examine the data and identify opportunities for improvement.
For example, project participants looked at research showing that women who are admitted to the hospital during the early stages of labor have a significantly higher risk of delivering by cesarean than women who are admitted during active labor.
They then developed an admission checklist that labor and delivery triage staff can use to assess patient readiness for admission. This tool promotes shared decision-making between the hospital team and the patient. Avoiding admission to the hospital during this earlier phase of labor has been linked to reduced cesarean deliveries, reduced use of epidurals and lower rates of maternal death.
In a recent article, Program Director Daniel Morgan, M.D. explained how the checklist can be especially useful during the early stages of labor. Hospital staff are using the checklist to help them identify who could spend this labor period outside of the hospital and helps them work together with the mother to provide appropriate support, he said. That way, mothers-to-be know what to expect and what to look for and work together with the maternity team to be safely admitted when they reach active labor — or before that if the maternity team thinks it’s best.
To learn more about the initiative, go to obstetricsinitiative.org.
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