ACOG Committee Statement No. 17
Abstract
The nulliparous, term, singleton, vertex (NTSV) cesarean birth rate is a metric that may be used to evaluate obstetric care and compare performance across similar hospitals and regions. Safe reduction of primary cesarean birth prevents the need for future cesarean births and associated maternal morbidity risk. Quality-improvement methodologies such as optimizing culture of care; practice environment; data collection and monitoring, including monitoring of data by race and ethnicity; and proactive management and planning for known and unanticipated drivers of cesarean birth may safely reduce NTSV cesarean birth rates. Obstetrician–gynecologists should engage with patients in informed decision making, informed consent, and birth preference conversations, particularly related to induction of labor and cesarean birth, to support equitable and respectful obstetric care and outcomes related to NTSV cesarean birth.
SUMMARY OF RECOMMENDATIONS AND CONCLUSIONS
- – Safe and equitable reduction of nulliparous, term, singleton, vertex cesarean birth should be a primary consideration in all settings providing high-quality obstetric care. This can be accomplished through quality-improvement initiatives.
- – Reducing the rate of nulliparous, term, singleton, vertex cesarean birth through quality-improvement initiatives requires fostering a transparent safety culture that emphasizes continuous improvement, engages health care teams with a solid understanding of physiologic birth processes, and is driven by reliable data.
- – Known risk factors and possible unforeseen issues in labor that may be drivers of cesarean birth, such as fetal positioning or fetal heart rate abnormalities, should be planned for and actively addressed in care during labor management and clinical workflows using specific evidence-based guidelines.
- – Practice environments should be optimized to support reduction of nulliparous, term, singleton, vertex cesarean birth, including access to required resources such as clinician and nurse staffing, equipment, and training. These optimized environments should be supported by policies and reimbursement strategies.
- – Patients should be supported through informed decision making for all aspects of labor management, including the incorporation of interventions undertaken during labor induction and during cesarean birth.