Safely Reducing Cesarean Sections Utilizing the PROVIDE Toolbox in a Faith-Based Hospital


Our team determined that standardization, elevating the patient’s voice, and team engagement were the keys to reducing primary cesarean section rates. We chose to focus on the low-risk population to make the greatest impact. Join us as we share our arduous but exciting journey to quality improvement.

Who: NTSV (Nulliparous, Term, Singleton, Vertex); first time giving birth; = or > 37 weeks gestation; one fetus; head down position

What: Low-risk cesarean sections made up 29.1% of births in this hospital. When we delved deeper into assessing the causation of the rate, several prominent themes came to the surface. One theme demonstrated that management preferences were widely varied among the providers. These variations were key drivers and contributed to the reason why these cesarean sections were occurring. Many of the providers have been in practice for an average of 15 years, and the nursing team has been practicing for an average of 12 years. These fascinating discoveries helped us develop a comprehensive plan to tackle the problem head-on.  

Where: A 340-bed faith-based hospital located in a suburban city of Florida. The team is made up of labor and delivery nurses, physicians, nurse managers, administrators, health unit coordinators, surgical technologists, anesthesiologists, and certified nurse anesthetists.

Why: To support women. Standardized care and improved quality enhance the patient experience and prevent unnecessary cesarean sections.

How: The strategic plan: To garner support and build momentum, we developed a plan to include specific interventions to promote change and mitigate barriers. I created an intervention called “Doula the Nurse” which provided a vehicle for mentoring and coaching to address the educational, physical, and spiritual needs of the nurses. We engaged the physicians by creating recognition boards to bolster a spirit of competition. The “Shared Mental Model” centered around everyone developing the same paradigm around safely lowering the NTSV cesarean section rate. Our theme was “OB PI (Obstetrics Performance Improvement) Superheroes.”

When: Join us to learn more about how to safely reduce primary cesarean sections at the upcoming ACNM 66th Annual Meeting, held virtually May 23-25, 2021.