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.

Significance

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

Goal

To reduce the number of cesarean deliveries among low-risk first births

Definition

Numerator: Cesarean delivery among term (37+ weeks), singleton, vertex births to nulliparous women

Denominator: All term (37+ weeks), singleton, vertex births to nulliparous women

Units: 100

Text: Percent

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: 23.9%)

Data Sources and Data Issues

Birth certificates

Data and Statistics

Key Websites

Policy Recommendations

Interventions

Further Reading

Related NCEMCH Resources

 

1 Health Resources and Services Administration. 2014. Title V Maternal and Child Health Services Block Grant to States Program: Guidance and Forms 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