Abstract
Faced with the high cesarean section (C-section) rate of 27%, which was well above the World Health Organization's (WHO) recommended rate of 15% and the industrialized nations' 7%, the leadership team of St. Dominic's Hospital in Manteca, California decided to implement a program to address the high-cost, high-risk, high volume of its C-section experience. An analysis showed that the overwhelming majority of its C-sections were attributable to a failure to progress in labor. Fetal distress and/or repeat or scheduled procedures accounted for a small percentage of total C-sections. The solution included better training for physicians and nursing staff, more aggressive coaching of patients by nursing staff, and developing an effective Pitocin dosing protocol. Results of the program were impressive: the C-section rate dropped to 12% and failure to progress dropped to 10% (from 24% in 1993). This achievement is important because, in the future, payers will select the hospitals that they will contract with for their obstetrical services based on the low C-section rate.
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