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Reducing The Primary Cesarean Section Rate

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Reducing the Primary Cesarean Section Rate in Nulliparous Women:
A Quality Improvement Project
Julie A. Javernick, CNM, MSN

Submitted to
Drs. Joan Nelson and Kathy Shaw of the University of Colorado College of Nursing in partial fulfillment of the requirements for NUDO 7018

Introduction
Background
Healthy childbirth is defined as a safe, natural process that rarely requires medical intervention (Goer & Romano, 2012). The medical model of care, however, often includes interventions that are not supported by the evidence and can increase a woman’s risk of having a cesarean section. These intrusions into labor and birth often lead to what has been called the “cascade of interventions” (DeClercq, Sakala, Corry,
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The Centers for Medicare and Medicaid Services are also requiring participating hospitals with more than 1,100 births a year to report their primary cesarean section rates. Theses rate will be published in 2016 (The Joint Commission, 2013).
Local Problem Lutheran Medical Center (LMC), one of eight hospitals in the Sister’s of Charity of Leavenworth Health System, had the second highest cesarean section rate in the system in 2014 (SCL Health, 2015). Westside Women’s Care (WWC), a privately owned obstetrics practice, employs 14 providers who attend approximately 65% of the births at LMC. WWC’s primary cesarean section rate from March 2014 to March 2015 was 34.8%, the highest of all LMC provider groups. The primary cesarean section rate in Colorado in 2012 was 17.4% and the Healthy People 2020 goal for primary cesarean section is 23.9% (Osterman & Martin, 2014; U.S. Department of Health and Human Services, 2015). To help decrease the primary cesarean section rate at WWC and subsequently LMC, a quality improvement project (QIP) team was formed composed of providers from WWC and administrators and nurses at LMC. A root cause analysis was conducted and Fishbone diagram were developed (See Appendix A). Several themes emerged as contributing to the high cesarean section rate. These included: 1)
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