Toward lower cesarean birth rates and effective care: five years' outcomes of joint private obstetric practice

Many ways to improve perinatal outcomes, deliver cost-effective care, and increase client and caregiver satisfaction have been suggested. This article adds to the body of such literature by describing a joint practice in California and reporting five years of its outcomes.

Frequency data were recorded prospectively for all pregnant women seen between January 1, 1991, and December 31, 1995. Overall statistics and variable-specific frequencies were then analyzed for the 1303 consecutive singleton births that occurred during this period.

The primary cesarean birth rate for the sample was 6.5 percent, the total rate was 9.1 percent, and the rate for women having their first full-term pregnancy was 11.3 percent. Of all women with a previous cesarean birth, 72.2 percent delivered vaginally. The success rate of attempted vaginal births after cesarean was 83.5 percent. Instrument deliveries were performed for 2.0 percent of births, and the frequency of third- or fourth-degree lacerations was 3.0 percent of all vaginal births. Transfers to a tertiary neonatal intensive care unit were 1.3 percent, and the perinatal mortality rate was 5.4 per 1000 births (corrected for serious anomalies: 3/1000). The preterm birth rate (including maternal transfers) was 2.0 percent.

An obstetric practice in a private community hospital setting that effectively used obstetricians, nurse-midwives, and nurse practitioners reported low rates of cesarean birth, preterm birth, severe lacerations, instrument deliveries, and legal incidents, and excellent cost-effective maternal and neonatal outcomes.