Relationship between Hospital Policies for Labor Induction and Cesarean Delivery and Perinatal Care Quality among Rural U.S. Hospitals

Abstract

Many hospitals are adopting quality improvement strategies in obstetrics. This study characterized rural U.S. hospitals based on their hospital staffing and clinical management policies for labor induction and cesarean delivery, and assessed the relationship between policies and performance on maternity care quality. We surveyed all 306 rural maternity hospitals in nine states and used data from the Healthcare Cost and Utilization Project Statewide Inpatient Database hospital discharge database. We found staffing policies were more prevalent at lower-volume hospitals (92% vs. 86% for cesarean and 82% vs. 79%, both p < .01). Using multivariable logistic regression, we found hospitals with policies for cesarean delivery had up to 24% lower odds of low-risk cesarean (adjusted odds ratio = 0.76; 95% confidence interval=[0.67-0.86]) and non-indicated cesarean (0.78 [0.70-0.88]), with variability across birth volume. Clinical management and staffing policies are common, but not universal, among rural U.S. hospitals providing obstetric services and are generally positively associated with quality.

The Role of Oxytocin in Primary Cesarean Birth Among Low‐Risk Women

“…Reducing the primary cesarean birth rate, especially among women who are nulliparous with a term, singleton, vertex fetus (NTSV), is a focus of quality and safety initiatives 1‐3 . Although maternal‐, health care provider‐, and system‐level factors influence primary cesarean birth rates, not all of them are amenable to intrapartum intervention 4‐12 . Oxytocin, a medication widely used in US intrapartum care to induce and augment labor, is associated with an increased risk for cesarean birth 13,14 .…”

“…[1][2][3] Although maternal-, health care provider-, and system-level factors influence primary cesarean birth rates, not all of them are amenable to intrapartum intervention. [4][5][6][7][8][9][10][11][12] Oxytocin, a medication widely used in US intrapartum care to induce and augment labor, is associated with an increased risk for cesarean birth. 13,14 This association may be mitigated by following guidelines for use, including requiring a medical indication, or turning the medication off when a woman is in active labor.…”