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August 9, 2017

How did this hospital cut its C-section rate to half the national benchmark? Patience.

Daily Briefing

SSM Health St. Mary's Hospital-St. Louis was able to cut its cesarean section rate for first-time, low-risk mothers to just half of a national benchmark simply by being more patient with their patients, Jennifer Thew writes for HealthLeaders Media.

Improve the quality of your hospital’s labor and delivery care with our toolkit

The hospital places no time limits on baby deliveries, and it does not perform elective inductions before 39 weeks of gestation. It also maintains a nurse-to-patient ratio that closely resembles the one-to-one ratio recommended by the Association of Women's Health, Obstetric and Neonatal Nurses. "That presence of the nurse to be able to support the mom in whatever kind of birth she's choosing is important," said Pam Lesser, the director of perinatal services at SSM Health St. Mary's. "(It) gives (the mom) the time and the support to get where she wants to be."

This approach has worked well for SSM Health St. Mary's, as it has lowered its C-section rate for first-time, low-risk mothers to 12 percent, well below HHS' national benchmark of 23.9 percent for low-risk births.

Lesser added, "If the baby is looking fine and tolerating what's going on and you've got the mom that you're supporting who's in it for the long haul, we have a team that is comfortable with just waiting on what, hopefully, is its natural progression."

Communication is key

Also central to SSM Health St. Mary's success is strong communication. The hospital follows the Agency for Healthcare Research and Quality's TeamSTEPPS model, which aims to improve patient safety by strengthening communication and teamwork skills.

"Everyone who works here is trained in that, but we really reinforce the importance of huddles, briefs, and debriefs to keep us all on the same page," said Lesser. "We do bedside handoffs with nurses so that the patient is included. Every shift we're updating and asking, 'Does this sound right? Are we on the right course for what you're wanting?'"

In particular, charge nurses lead a team review of the care management plan for every patient in labor and delivery. The review includes anesthesiologists, neonatologists, nurses, and obstetricians, who all discuss whether their care management plan is on track or needs to be updated.

"We come together and look at the data we have—be it the patient experience, vital signs, or monitor strips," said Lesser. "(We discuss) the best way we can go to move forward to help the mother achieve what she wants and what we know is safest, which is a vaginal birth if all else is looking OK" (Thew, HealthLeaders Media, 8/1).

Improve the quality of your hospital’s labor and delivery care

Perinatal care is a high-volume service, accounting for one-fifth of all hospital stays. Yet it is also highly variable, with significant differences in complication rates for both vaginal and cesarean deliveries between hospitals nationwide.

This toolkit includes best practices and resources collected from organizations that have successfully improved labor and delivery care by reducing clinical variability.

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