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Upcoming
important dates, next steps for the SIVB Initiative...
(The Support for Birth initiative's weekly email newsletter comes out every Tuesday. As a reminder, it is your job as key contact to share relevant information with other team members at your hospital.)
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The Green Journal addresses the rising c-section rate again
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In a Commentary from the September 2011 edition of Obstetrics & Gynecology (the Green Journal), available here, Dr. Howard Blanchette provides a thorough overview of why the U.S. c-section rate is as high as it is, and how to address it. The piece, entitled "The Rising Cesarean Delivery Rate in America: What can be done about it?", addresses the increasing role of primary elective c-sections and the decline in the past 15 years in the rate of women attempting TOLAC. Dr. Blanchette points to the recent (since 1998) increase in maternal mortality that is in part associated with complications related to c-sections in women with abnormal placentation and reminds us that the increase in c-sections has not been associated with significant improvements in neonatal morbidity or maternal health.
This commentary concludes with the following statement: "...we as obstetricians must reduce the primary cesarean delivery rate, and avoid the performance of a uterine incision unless absolutely necessary for fetal or maternal indications." Other recommendations include:
· Avoiding cesarean delivery for dystocia until active labor is firmly established, particularly in nulliparous women and in induced labor
· Promoting TOLAC for women with one previous LTCS who desire 3 or more children
· Extensive counseling for women requesting primary elective c-section on maternal risks, particularly if they desire several children
· Maintaining competence in FHR interpretation among MDs, CNMs and RNs
· Compenstating obstetricians equally for a TOLAC as for an elective repeat c-section
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| Balancing Measures |
| As part of SIVB data collection, we are tracking the rate of maternal and neonatal complications to ensure that there are no unintended adverse consequences of any potential reduction in the c-section rate that we might achieve. Since there has been a reduction in the c-section rate among participating hospitals this summer, we took a new look at these "balancing measures". Furthermore, as the following slide suggests, there may be a slight increase in the rate of operative vaginal deliveries.
(click here for larger image)
The slide below shows the rate of each of the maternal complications we are monitoring. There does not appear to be a consistent trend in any of these rates.
(click here for larger image)
Finally, among neonatal complications, while there does not appear to be a consistent trend among most of the neonatal complications we are watching (these include 5-min Apgar <6, NICU admission, meconium aspiration syndrome, cord pH <7.0, seizures, brachial plexus injury, subgleal hematoma, clavicular fractuce, humerus fracture, laceration of neonate), the number of infants with cephalomenatoma may be increasing, as reflected in the table below.
We have not tested these rates for statistical significance, and the numbers are extremely small, but we wanted to share this data for your consideration. One possibility is that over time we are seeing improved data collection of this complication. We will continue to monitor complication rates and work with our statistical support team to evaluate their significance.
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Reminder of upcoming dates
| | |  The September webinar will be held on Tuesday September 27 at 7:30am.
The next learning session will be held on Wednesday November 2 in Raleigh at the McKimmon Center.
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Contact Kate
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Kate Berrien, RN, BSN, MS
UNC Center for Maternal & Infant Health
CB# 7181
Chapel Hill, NC 27599
kberrien@unch.unc.edu
Phone: 919-843-9336 Fax: 919-843-7866
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