Understanding the factors increasing cesarean delivery and impacting quality care
Methods: Obstetrician/gynecologists in LAC completed a self-administered questionnaire to assess their practices and attitudes related to c-sections.
Results: 117 obstetrician/gynecologists responded. The practice types were 37.4% (44/117) solo practice, 33% (39/117) group and 16.5% (19/117) university/teaching practices. Medicaid was the primary method of payment accepted, followed by private PPO, private HMO and other. Reasons cited for performing c-sections the month prior were failure to progress, fetal distress, failed induction, cephalo-pelvic disproportion and maternal complications (pre-eclampsia). 55% stated the threat of litigation drove them to recommend a cesarean delivery and 45% to discourage a VBAC. 53% stated their hospital c-section rate was too high. Although providers delivered at several hospitals, 98% of their primary affiliation had 24-hour in-house anesthesia. 95% stated they follow the ACOG recommendation of no elective delivery less than 39 weeks gestation. Email (85%) and medical conferences (33%) were the preferred methods of obtaining medical information.
Conclusion: The threat of litigation was cited as reason to perform a cesarean and not recommend a VBAC. In-house anesthesia was cited as important to have in their primary delivery hospital. ACOG practice recommendations were followed by participants. E-mail was the preferred method of obtaining medical information/recommendations. Patient quality of care and delivery of care is influenced by provider threat of litigation. A multi-pronged approach, working with providers, hospitals, malpractice companies and patients, is needed to address the most common cesarean section drivers.
Learning Areas:Provision of health care to the public
List the most common reasons for c-sections Describe the solutions to imporivng the qualilty of care in labor and delivery
Keyword(s): Perinatal Outcomes, Quality of Care
Qualified on the content I am responsible for because: I am an ob/gyn, director for reproductive health with extensive experience in developing and implementing quality care programs.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.