Primary Cesarean Delivery Prevention

Abstract

INTRODUCTION: Reducing the cesarean delivery rate is a national priority. Obstetrician–gynecologists working in collaboration with certified nurse-midwives demonstrate that a Collaborative Model of Care has the potential to yield the very best obstetric outcomes. This model is based on 1) screening criteria; 2) antepartum guidelines; 3) communication patterns of consultation, collaboration, and referral; 4) evidence-based intrapartum guidelines; 5) innovative labor management strategies; 6) removal of time limits for labor progress; and 7) availability of operative vaginal and breech delivery. METHODS: This is an observational report and data analysis of the first 1,000 deliveries managed by certified nurse-midwives in consultation with obstetrician–gynecologists in a Collaborative Model of Care in an academic medical center from 2010 to 2013. RESULTS: Outcome data from this innovative Collaborative Model of Care show a cesarean delivery rate of 3.6% and a primary cesarean delivery rate of 2.6%. If antepartum transfers at term are included in the analysis, the cesarean delivery rate is 5.6%. The model yields an 88% normal vaginal delivery rate and a 12% epidural rate. The vaginal birth after cesarean delivery success rate is 93%. Vaginal breech birthrate is 75%. The neonatal intensive care unit transfer rate is 5%. CONCLUSIONS: A Collaborative Model of Care between obstetrician–gynecologists and certified nurse-midwives in a university-based setting has the potential to significantly reduce the cesarean delivery rate. Duplication of this model in diverse patient populations will significantly reduce the national cesarean delivery rates, increase rates of normal vaginal delivery, and yield optimal outcomes for our nations' mothers and neonates.