1.1.c: Decrease the Primary Term Single Vertex (TSV) C-section rate from 15.8% to 14.7% by 2018

Why is this a priority?

C-section rates in Washington State rose rapidly starting in 1996 and have plateaued in recent years. For most low-risk pregnancies, cesarean delivery is associated with higher rates of maternal and neonatal complications or death. The rapid rate increase of C-sections without associated maternal or neonatal complications or death raises significant concern that C-section delivery is overused. C-section births associated with non-medically indicated induction of labor between 37-39 weeks are, in particular, associated with poorer neonatal outcomes. Reducing unnecessary primary C-section deliveries will result in improved maternal and neonatal outcomes.

How are we doing?

WA C-section rates currently at 13.8% and has been fairly steady for last 8 years. Washington State does better than the US overall in terms of C-section rates. The WA and US trends for C-sections are very similar. One of the improvements that needs to be made is reducing the wide variation between hospitals.

What are we working on?

  1. Publicly reporting statewide, hospital-specific C-section rates (ongoing)
  2. Requiring Medicaid Managed Care Organizations to undertake coordinated and specific QI efforts to reduce unnecessary C-sections in their contracted hospitals and provider networks (ongoing)
  3. Disseminating a compendium of evidence-based best practices with respect to OB care and delivery (ongoing)
  4. Partnering with DOH in support of WSHA's Safe Deliveries Roadmap Initiative (ongoing)

Action Plan:

Reported by: Health Care Authority