IMPACTING CESAREAN SECTION RATES IN LOW-RISK NULLIPAROUS LABORING WOMEN

Cesarean births, when conducted for medical indications, can improve both maternal and fetal outcomes, however, when performed for non-medical reasons, increase mothers’ and their babies’ risk for negative outcomes. Women are considered low risk for cesarean birth if they are giving live birth for the first time, with a single full-term fetus in the vertex or head down position, known as nulliparous, term, singleton, vertex, or NTSV. Despite low risk among this population, first-time cesarean births represent the largest category of cesarean births. This doctoral quality improvement project aimed to reduce the rate of cesarean sections among low-risk nulliparous laboring women at WakeMed Cary Hospital using standardized, evidence-based guidelines and decision-making tools from the 2022 California Maternal Quality Care Collaborative (CMQCC) Toolkit to Support Vaginal Birth and Reduce Primary Cesareans. Nurses used the “Spontaneous Labor Algorithm” and the “Induction of Labor Algorithm” to guide care decision-making. At the same time, the “Pre-Cesarean Communication Tool for Labor Dystocia or Failed Induction” (CMQCC, 2022, p.142) served as a checklist to facilitate conversation with providers and track compliance with the evidence-based standards of care provided by each algorithm. From June 9th to July 20th, 2024, Wake Med Cary Women’s Pavilion delivered 394 babies. Of these 394 patients, n=153 (38.8%) met the NTSV criteria. Sixteen of 75 (21.33%) NTSV patients delivered in June, and 23 out of 78 (29.48%) NTSV patients delivered in July experienced a cesarean section. Although project outcomes (June, July, August) were not statistically different from baseline data (March, April, May) (t(2)=0.0853, p=0.9398), this project identified many important implications for practice. First, change strategies must target healthcare decision-makers, in this case, obstetric providers rather than labor nurses. Next, this project highlighted the importance of standardized practice guidelines and how practice discrepancies, even within a single organization, impact patient outcomes, such as the NTSV cesarean birth rate. Therefore, standardizing care practices and organizational policies is vital in reducing the risk of negative outcomes associated with unwarranted cesarean births for both mothers and their babies.