A series of improvement projects led by obstetrical care providers at the Cypress Regional Hospital have resulted in an important reduction in C-section birth rates. Between 2012 and 2015, the rate fell from 34% to 27% overall, and from 20% to 15% in mothers having a first-time procedure. These results place the region below the Canadian averages for overall C-sections (27.5% in 2014/15) and first-time procedures (18.5%).
“Caesarean births have become much more common over the past two decades in our health region and across Canada,” advised Epidemiologist Dr. Brandy Winquist. “While a reduction of seven percentage points may seem small, it is really quite an extraordinary task, a trend we hope to see continue.”
C-sections can be lifesaving in some cases, but dramatic increases in rates have raised questions about when this surgery is medically necessary and when it is not. Given the complexity of factors driving C-section rates, it is important that any improvement effort be informed by local data.
In 2013, Drs. Kevin Wasko and Brandy Winquist led the design and implementation of a research study to gain a better understanding of the differences between mothers who gave birth by C-section and those who delivered vaginally. The project, a collaboration between the University of Saskatchewan’s Department of Family Medicine and the Cypress Health Region, studied more than 600 births. Findings from the study have since been used to direct improvements and to support an evidence-based approach.
One example is the launch of an awareness campaign to promote vaginal births after caesarean (VBAC) birth. After learning that almost half of Caesarean births were in mothers who had a previous C-section, educational materials were developed to help counsel mothers about the risks and benefits of opting for a repeat surgery or trying for a vaginal birth. The VBAC campaign focused on sharing women’s stories and promoting the health and recovery benefits of VBAC.
“When compared to a traditional delivery, C-sections can result in higher risks of infection, a longer stay in hospital, and an overall slower recovery. These are all important considerations and they prompted our entire team to really focus on how we could work together to reduce the C-sections rates in our region.”
(Dr. Kevin Wasko, Family Physicia)
“As providers we are aware of the risks of C-sections, but we felt that the general public and specifically pregnant women needed to also know the risks,” said Dr. Wasko. “We used the VBAC campaign to help share some of the benefits of traditional deliveries even for those who have previously delivered children via Caesarean section.”
A multidisciplinary obstetrics team was established in 2011 to discuss issues and best practices within Cypress Health. The team meets every three months and includes physicians, obstetricians, pediatricians, nursing staff, managers, pharmacists, midwives, and an epidemiologist. This team worked together to begin the Salus Global moreOB™ program in early 2015. Managing Obstetrical Risk Efficiently (moreOB™) is a continuous patient safety improvement program for all members of the multidisciplinary team. It is a collaborative approach built to decrease adverse events and clinical errors and also to improve care in ways that will reduce risk for C-section births.
“We have a very engaged team of physicians and nurses working on the women and children’s ward. What really sets this group apart is how invested people are to make improvements for our patients.”
(Dr. Kevin Wasko)