Cesarean Births Among Low Risk First Births
The Maternal and Child Health Bureau (MCHB) Title V Maternal and Child Health
Services Block Grants to States Program has established 15 National Performance
Measures for the 2015-2017 grant cycle. Performance Measure 2 is the percent of cesarean deliveries among low-risk first births.
This evidence brief points to a selection of resources for state MCH programs on cesarean births among low risk first births, with an emphasis on evidence based information.
The Title V Maternal and Child Health Services Block Grant to States Program guidance1 defines the significance of this goal as follows:
Cesarean delivery can be a life-saving procedure for certain medical indications. However, for most low-risk pregnancies, cesarean delivery poses avoidable maternal risks of morbidity and mortality, including hemorrhage, infection, and blood clots— risks that compound with subsequent cesarean deliveries.
Much of the temporal increase in cesarean delivery (over 50% in the past decade), and wide variation across states, hospitals, and practitioners, can be attributed to first-birth cesareans. Moreover, cesarean delivery in low-risk first births may be most amenable to intervention through quality improvement efforts. This low-risk cesarean measure, also known as nulliparous term singleton vertex (NTSV) cesarean, is endorsed by the ACOG, The Joint Commission (PC-02), National Quality Forum (#0471), Center for Medicaid and Medicare Services (CMS) - CHIPRA Child Core Set of Maternity Measures, and the American Medical Association-Physician Consortium for Patient Improvement.
Read More about Performance Measure 2
Performance Measure 2
Percent of cesarean deliveries among low-risk first births
To reduce the number of cesarean deliveries among low-risk first births
Cesarean delivery among term (37+ weeks), singleton, vertex births to nulliparous women
All term (37+ weeks), singleton, vertex births to nulliparous women
Healthy People 2020 Objectives
Related to Maternal, Infant, and Child Health (MICH) Objective 7.1. Reduce cesarean
births among low-risk women with no prior cesarean (Baseline: 26.5%, Target:
Data Sources and Data Issues
Data and Statistics
- Johnson K. From Evidence to Improved Policy and Program Practices: Low-Risk Cesarean Deliveries. 2014. National Center for Education in Maternal and Child Health. Georgetown University: Washington, DC.
- McCoy C. 2014. State Title V program approaches to improving birth outcomes. Washington, DC: Association of Maternal and Child Health Programs.
- National Quality Forum Maternity Action Team. 2014. Playbook
for the elimination of early elective deliveries. Washington, DC: National Quality Forum.
- Spong CY, Berghella V., Wenstrom KD, Mercer BM, Saade GR. 2012. Preventing
the first cesarean delivery: Summary of a joint Eunice Kennedy
Shriver National Institute of Child Health and Human Development,
Society for Maternal-Fetal Medicine, and American College
of Obstetricians and Gynecologists Workshop. Obstetrics
and Gynecology 120(5):1181-93.
- Strong Start for Mothers and Newborns Initiatives. A joint effort between the Centers for Medicare & Medicaid Services, the Health Resources and Services Administration, and the Administration on Children and Families. Strong Start strategies include the Effort to Reduce Early Elective Deliveries and Enhanced Prenatal Care Model that will test evidence-based maternity care approaches.
- Vanderbilt Evidence-Based Practice Center. 2012. Strategies
to reduce Cesarean birth in low risk women. Rockville, MD: Agency for Healthcare
Research and Quality. (Comparative Effectiveness Review; no. 80)
- Caughey AB, Sundaram V, Kaimal AJ, Cheng YW, Gienger A, Little SE, Lee JF, Wong L, Shaffer BL, Tran SH, Padula A, McDonald KM, Long EF, Owens DK, Bravata DM. 2009. Maternal
and neonatal outcomes of elective induction of labor. Rockville, MD: U.S. Agency for Healthcare Research and Quality. (Evidence reports/Technology assessments; no. 176).
- Caughey AB, Sundaram V, Kaimal AJ, Gienger A, Cheng YW, McDonald KM, Shaffer BL, Owens DK, Bravata DM. 2009. Systematic
review: elective induction of labor versus expectant management of
pregnancy. Annals of Internal Medicine 151(4): 252-263.
- Sakala, C. 2014. Cesarean
section: A growing focus on maternity care quality improvement. Member Briefs. Washington, D.C.: Association of Maternal and Child Health Program.
- Sakala C, Corry MP. 2008. Evidence-based
maternity care: What it is and what it can achieve. New York, NY: Milbank Memorial Fund. Provides a framework for understanding evidence-based maternity care, including the relationship between evidence about human psychology and evidence about specific maternity practices such as Cesarean sections.
Related NCEMCH Resources
1 Health Resources and Services Administration. 2014. Title V
Maternal and Child Health Services Block Grant to States Program: Guidance
for the Title V Application/Annual
Report, Appendix F, p.75.
Cesarean Births Among Low Risk First Births: Evidence Brief, 1st ed. (November 2014).
Author: Beth DeFrancis, M.L.S., NCEMCH