In December, teams across North Carolina had a slight upward trend of an increased cesarean rate among patients without risk factors. However, the overall cesarean rate for participating teams continues to decline with a continued statistically significant downward trend in the cesarean rate for patients with one or more risk factors for a cesarean (i.e. diabetes, IUGR, advanced maternal age, hypertensive disease, macrosomia, and obesity).
This month, hospitals were asked to complete a demographic survey answering questions determined by teams at the November Learning Session in Raleigh. Survey questions consisted of: the number of annual deliveries, the epidural rate, whether or not there is in-house anesthesia or in-house OB/GYN physicians or midwives on staff, whether or not there is 1:1 nursing care with patients on Oxytocin, and if there is a policy for not electively delivering before 39 weeks, 40 weeks or 41 weeks gestation. Half of the hospitals have completed the survey and full results will be presented upon completion of the survey by all hospitals. To date, hospitals that have completed the survey have shown a statistically significant difference in lower cesarean rates when midwives are on staff and ~54% (that have completed the survey) have a policy in place for not allowing elective deliveries < 39 weeks while ~15% have a policy for not allowing elective deliveries < 41 weeks gestation. Another question on the survey regarding hospitals with a policy for elective deliveries is showing a direct correlation between lower cesarean rates with greater weeks gestation (i.e. 39 weeks to 41 weeks gestation).
