Reducing Rates of Cesarean Birth and Cesarean-Linked Hemorrhages through Improved Obstetric Care

Modified Project Summary/Abstract Section Almost 1 in 3 births in the United States involves cesarean delivery. A lifesaving intervention when appropriate, cesarean, and the labor and obstetric care factors connected to cesarean, are associated with significant risks that include severe postpartum hemorrhage and severe maternal morbidity (SMM). Compared to vaginal delivery, women undergoing cesarean delivery incur the highest risk of postpartum hemorrhage and hemorrhage-related morbidity. Reducing cesarean rates by addressing obstetric care practices which may be contributing to cesarean birth is therefore essential for reducing postpartum hemorrhage and postpartum-related SMM. This effort requires multifaceted, multilevel interventions that can be deployed at scale. We will build on our expertise in achieving population-level improvements in maternal outcomes (including hemorrhage and cesarean delivery) and long-standing collaborative partnerships with patients, communities, and public health agencies to identify and implement strategies to reduce cesarean rates and address variability in obstetric care which may be contributing to cesarean birth and hemorrhage. Our state-wide quality improvement network with a sophisticated real-time data center will enable us to support complex interventions and track improvement. Capitalizing on our collaborative network of 218 hospitals covering 99% of births in CA, we will realize the following Specific Aims: (1) Use mixed method approaches to identify strategies to improve obstetric care practices which may be contributing to cesarean birth rates and cesarean-associated hemorrhages. (2) Center patient voices in the validation and continuous curation of action tools and resources that will be integrated into a Hospital Action Guide, a toolkit of resources to drive change within hospitals. (3) Expand implementation of the Hospital Action Guide to state-wide efforts. (4) Assess effectiveness of the Hospital Action Guide tools/resources and implementation strategies. We collect real-time patient-level data for all California births allowing us to measure changes in multiple maternal health outcomes at state, hospital, and even provider levels. Combined with qualitative methods, this will provide a particularly robust analysis of effectiveness of our interventions. Results will establish a national roadmap for effective, large-scale quality improvement to reduce rates of cesarean births with potential application to other aspects of obstetric care.