News Release: March 25, 1998

Albuquerque, NM -- According to the Public Citizen's Health Research Group in Washington, D.C., there were 473,000 unnecessary cesarean sections (c-sections) performed in the United States in 1991. Many women know that a c-section sometimes means a longer hospital stay with recovery time and complications. In 1995, with that knowledge in mind, the Presbyterian Women's Program embarked on a project to lower its c-section rate to less than 18% of all births. In 1995, the c-section rate for the Hospital stood at 19.25%. Since implementing a series of strategic initiatives two and 1/2 years, the Women's Program has lowered its c-section rate to 16.04% with evidence that newborns have remained healthy.

"What's important here, is that we are helping mothers. Last year we performed 101 less c-sections. It's been a win-win situation for everybody. Above all, the mother and child have benefited, as well as physicians and Presbyterian, said Sam Smith, MD, Women's Program Medical Director.

Although the goal was to lower the rate to below 18%, the Women's Program had to make sure that the overall health of newborns remained the same. Before the project began, two quality measures of a baby's health at birth were identified. Apgar scores of newborns and percentage of newborn babies older than 34 weeks admitted to the neonatal intensive care unit. (An Apgar score measures the ability of a newborn baby to accommodate to its new environment immediately after birth.) These two measures have actually improved since implementation of the new initiatiatives.

For most mothers, the advantages of not having a c-section are many. Some advantages are that women are not exposed to abdominal surgery so there are no risks associated with bleeding, infection and accidental injury. Also, the mother and child spend less time in the hospital and less intensive nursing care is required for the mother.

"Women are able to return to normal activities sooner when they don't have a c-section," said Marti Martienssen, director of Presbyterian Women's Program. "Also, a normal vaginal delivery may be more fulfilling for a woman."

The Women's Program used four different methods to lower the c-section rate. The first method was to raise awareness among obstetricians and other physicians who deliver babies at Presbyterian Hospital. Information was provided monthly to physicians comparing them with the other physicians (anonymously) based on the quality measures. The Women's Program began sharing that information in November 1996.

"It motivated the physicians to look at their own rates and see how they compared and possibly make changes in their practice styles," said Smith.

The second method was to formalize the management of "failure to progress." Failure to progress is a term used when the baby is too big to fit through the birthing canal. All the physicians were quite familiar with the problem but had slightly different management approaches. By establishing a standard guideline, physicians have a ready reference to the standard of care as outlined by medical literature and the American Colleges of OB/GYN. Failure to progress accounts for 30% of all c-sections. The guideline offered the Women's Program the best opportunity to impact the overall c-section rate.

The third method was to redefine the criteria for admission to labor and delivery. A triage area was established so that only women who were in active labor were admitted. This allowed the labor and delivery personnel to focus only on patients who were actively progressing through labor.

The fourth method was the increased usage of certified nurse midwives (CNM). In 1996, the percentage of women who delivered at Presbyterian Hospital using a CNM was about 3%. In 1997, the figure jumped to 9.5%. Nationwide, CNMs have a lower c-section rate and today are delivering more and more babies. Their practice style promotes a lower risk approach to the management of labor. The CNMs also shared their labor management techniques with the nurses and physicians.

"The certified nurse midwives work collaboratively with nurses and physicians. These three groups of professionals are utilizing many techniques to help women through labor," said Martienssen.

Lowering the c-section rates has also meant that the Women's Program has lowered the cost of delivering a baby by 12%. Cost reductions have occurred because a mother and child spend less time in the hospital and the physician and hospital fees are reduced. Other reductions include laboratory, pharmaceutical, and anesthesia costs. Overall, the Women's Program has achieved cost savings of roughly $137,500.

Presbyterian Women's Program provides a broad range of comprehensive services for all women including obstetrics and gynecological services, and inpatient and outpatient services. The Women's Program is owned by Presbyterian Healthcare Services (PHS), a New Mexico owned not for-profit delivery system. Presbyterian has been providing health care for New Mexicans since 1908. The organization owns, manages, or leases a statewide network of services including hospitals, outpatient centers, a health plan, and physician groups.