| | Births by Cesarean and Vaginal Births after Cesarean
IMPACT
A vaginal delivery is the preferred, naturally-designed way to have a baby but when needed, delivery by Cesarean section is a second option. At Gundersen Lutheran, efforts are made to choose a vaginal birth, even after a previous C-section unless there are reasons that would put mother or baby at risk.
“Generally, successful VBAC is associated with shorter maternal hospitalizations, less blood loss and fewer transfusions, fewer infections, and fewer thromboembolic events than cesarean delivery.” (1)
AIMS
1. To have a cesarean section rate below the national rate
2. To have a VBAC rate higher than the national rate
RESULTS
CONCLUSIONS
Gundersen Lutheran’s cesarean rate is significantly better (lower) than the national average over the entire time period (p<0.001) and the VBAC rate is significantly better (higher) than the national average.
NEXT STEPS
Continue to monitor the data and strive to provide optimal patient care.
LEADER: You may contact the activity leader for more information if desired.
Ted Peck, M.D.
BACKGROUND
There is no consensus on the optimal rate for cesarean sections, and there is considerable variation in these rates nationwide. Cesarean section rates depend on a number of factors including patient mix, physician/midwife experience, hospital size, and labor management practice (2)
Nationally, since 1996 the rate of cesarean delivery has continued to rise and data for 2005 shows a 46% increase to 30.3%. (3)
“The continued escalation in the total cesarean rate is being driven by both the Increase in the primary cesarean rate and a steep decline in the rate of vaginal birth after cesarean delivery (VBAC). For over two decades the risks, benefits, and long-term consequences of cesarean and vaginal birth after cesarean (VBAC) delivery have been debated; recently there has been intense discussion regarding whether cesarean delivery should be performed when there is no medical or obstetrical indication for the procedure.” (3)
METHODS/MEASURES
The cesarean delivery rate is computed as the percent of all births delivered by cesarean. The VBAC rate is computed by dividing the number of patients who have a successful vaginal delivery after previous cesarean delivery by the number of patients who had a previous birth by cesarean. Gundersen Lutheran’s numbers are derived from patients discharged during the calendar year and include all births. National data includes live births only. The cesarean rates were compared statistically using the 95% confidence interval.
BENCHMARK
The U.S. rate is used as a benchmark. Data are derived from birth certificates registered in all states and the District of Columbia and are published in the National Vital Statistics Reports.
REFERENCES
(1) Porter TF & Zelop CM. (2004, July) Vaginal Birth After Previous Cesarean Delivery. ACOG Practice Bulletin, 54.
(2) Rooney BL, Thompson JE, Schauberger CW & Pearse CA. (1995) Is a 12% cesarean section rate at a perinatal center safe? Journal of Perinatology.
(3) Martin JA, Hamilton BE, Sutton P, Ventura S, Menacker F, Kirmeyer S & Munson ML. (2007, December 5) Births: Final Data for 2005; National Vital Statistics Reports, 56 (6). Hyattsville, Maryland: National Center for Health Statistics.
ACKNOWLEDGEMENTS
Jane Robinson, RHIA, Quality and Performance Improvement
Jeff Falk, MS, Biostatistician |