Creating a Public Agenda for Maternity Safety and Quality in Cesarean Delivery

• DOI: 10.1097/aog.0b013e31826fc13d
• Publication Date: 2012-10-09T06:55:56Z
• Authors: Elliott K. Main; Christine H. Morton; Kathryn Melsop; David Hopkins; Giovanna Giuliani; Jeffrey B. Gould
• Keywords: Cesarean delivery; Maternity care

Cesarean delivery rates in California and the United States rose by 50% between 1998 2008 vary widely among states, regions, hospitals, health care providers. The leading driver of both rise variation is first-birth cesarean deliveries performed during labor. With large increase primary deliveries, repeat now has emerged as largest single indication. economic costs, risks, negligible benefits for most mothers newborns these higher point to urgent need a new approach working with women This commentary analyzes high wide variations presents evidence costs risks associated (complete discussion provided Maternal Quality Care Collaborative White Paper at www.cmqcc.org/white_paper). All stakeholders ask whether society can afford complications this rate they work together toward solutions. factors involved multistrategy approach, because no strategy likely be effective or lead sustained change. We outline complementary strategies reducing offer recommendations including clinical improvement careful examination labor management practices; payment reform eliminate negative perverse incentives; education recognize value vaginal birth; full transparency through public reporting continued engagement.