Decreasing Primary Cesarean Births by Increasing Effective Maternal Care at a Community-Based Hospital

Background: Nulliparous cesarean birth rates have plateaued at 25% since 2019. Cesarean births contribute to 37% of severe maternal morbidity and can increase costs by longer lengths of stay, increased admissions to the neonatal intensive care unit, further postoperative complications, and an increased likelihood of subsequent cesarean births. Local Problem: At this community hospital, the rate of cesarean births for nulliparous, term, singleton, and vertex (NTSV) pregnancies rose almost 3% in 2022. This quality improvement (QI) project was aimed to decrease NTSV cesarean births by increasing effective maternal care by 80% at a community-based hospital. Methods: The Plan-Do-Study-Act model was applied for this rapid-cycle QI over 8 weeks with four 2-week cycles. The data were collected every other day, reviewed biweekly to inform data collection, and analyzed for the next test of change. Interventions: A patient screening tool was used to identify nulliparous mothers, and a patient effective care checklist tool was used to improve effective maternal care. Results: Staff utilization overall resulted in 81% screening of 215 mothers and identified 116 nulliparous mothers. The average effective care score was 84%. The checklist improved effective maternal care to 84% and reduced the NTSV cesarean births by 7%. Conclusion: Identifying nulliparous mothers on admission and then providing effective care to women in labor has the potential to decrease the NTSV cesarean birth rate. It can be utilized by every laboring mother, furthering the reduction of cesarean births.