The March of Dimes effort to reduce or eliminate elective deliveries and C-sections has led to thousands of women not having major unnecessary surgery and babies who would have required NICU care who instead had a superior birthing experience. This might be the single most meaningful accomplishment ever for the March of Dimes. We should all say: “Thank You, March of Dimes!”
Over the past ten years, the March of Dimes has pursued an ingenious and determined campaign to reduce or eliminate elective deliveries of babies less than 39 weeks gestation. While the evidence has been available for years, actual practice in medicine in maternity units across most of the United States was actually moving away from the research. A thoughtful, more evolved group of California physicians and at least one obstetric Clinical Nurse Specialist worked to create a new guideline. Eventually this led to a hospital tool-kit involving policies and procedures to define what would be acceptable practice regarding gestational age, induction and electivity in admitting, treating and delivering patients in the maternity area of the hospital either by normal vaginal or by surgical delivery. Ultimately this research and tool kit was licensed, branded and promoted by the March of Dimes nationwide. While there appear to be some outlying hospitals and physicians resisting these new policies, these same hospitals and physicians are coming under increasing scrutiny as consumer groups, Centers for Medicare and Medicaid Services(CMS), and state health departments seek to identify the over half million women who statistically need neither induction nor a C-Section. At the moment, the national data most recently released by the Centers for Disease Control (CDC) indicate we’ve hit the high tide mark in the United States for an annual C-sections just under 1/3 of all deliveries.
Some hospitals have made outright bans on elective deliveries and labor inductions. The effect is, that for the first time since 1996, the number of surgical C-sections have stopped climbing. Now the heavy lifting begins with Accountable Care Organizations likely seeking to reduce these numbers which are still historically high and reduced numbers of C-Sections will be incented under the new programs as measurements become more precise. There is no doubt that the number of surgical deliveries should continue to drop across the nation under the continued attention and full implementation of the hard-stop policy contained in the March of Dimes program.
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The halt to increasing rates of C-Sections in our nation is a testament to the tireless and focused pursuit of best practice and patient focused care largely by maternity nurse leaders and maternity nurses in collaboration with delivering physicians. Some of these people in the front line experienced some tremendous pushback in this effort and deserve some accolades that some hospital administrators should recognize in public appreciation. There probably isn’t a Labor and Delivery manager or Women’s Services Director who didn’t have several tense conversations and meetings over the past five years. When the U.S. c-section rate was first measured almost 50 years ago, it was 4.5%. In a study by HealthGrades, as of 2009, the highest rate statewide found was in Florida at just under 40% and the lowest state in the nation was Utah was just over 22%. What this means is there is still dramatic gains to be made in this area of childbirth.
