This member-only article appears in the May issue of Patient Safety Monitor Journal.
Next year, patients and potential parents will have one more metric by which to judge your hospital. Starting July 2020, The Joint Commission (TJC) will publicly report hospitals that have consistently high C-section rates on its Quality Check website.
Hospital rankings will be based on TJC’s perinatal care (PC) Cesarean Birth measure PC-02. Hospitals accredited by TJC are already required to report that data to the accreditor, but this will be the first time it’ll be visible to the public.
TJC will only track the number of C-sections done on nulliparous, term, singleton, vertex (NTSV) births—procedures performed on first-time mothers carrying a single baby that has its head facing down at the onset of labor. The three ranking criteria are:
≥ 30 cases reported in both years
PC-02 rate > 30% for the current year
Overall two-year average PC-02 rate > 30%
Hospitals will be marked with a plus sign (an acceptable rate) or a minus sign (a high rate) next to the PC-02 measure on the Quality Check website. The first round of reporting will come from data gathered in 2018 and 2019. If the numbers remain similar to data collected in 2016 and 2017, about 20% of facilities will be past the C-section threshold.
In a blog post, TJC Executive Vice President David Baker, MD, cited stagnant C-section rates as the motive behind initiating this public reporting. According to TJC, PC-02 rates have remained around 26% since 2010, without improvement. And in 2017, 25% of reporting hospitals had NTSV C-section rates over 30%.
Nationally, the CDC says that 32% of all babies born that year were delivered by C-section. That’s 1,232,339 births in a single year.
“The Joint Commission decided to move forward in reporting high C-section rates after conducting analyses that showed no improvement in C-section rates over the last several years—along with new evidence that hospitals can safely reduce their cesarean section rates without an increase in neonatal complications, and new guidance from the American College of Obstetrics and Gynecology on reducing cesarean section rates,” he wrote in a separate Q&A on the topic.
Risks of the procedure
If used properly, a C-section can be a life-saving procedure. That said, it’s still a major surgery and comes with potential health risks. For newborns, those risks include surgical injury or breathing problems like transient tachypnea. For mothers, the risks include infection, hemorrhaging, blood clots, and increased likelihood of future birth complications.
One notable risk to mothers is placenta accreta, in which the placenta invades the uterine walls, causing bleeding after the baby is delivered. The condition can be caused by scarring from previous C-sections. It occurs in one out of 500 births and kills one in 14 mothers who get it, usually due to blood hemorrhaging.
Paula Turicchi, FACHE, is senior vice president of women & infants specialty health at Parkland Health & Hospital System in Dallas. She says both physicians and patients contribute to the high C-section rates. Sometimes physicians will plan C-sections in advance to have more control over their schedule, she says. But some patients will also request a C-section for their own reasons.
“If you were looking 50 years ago compared to the recent past, we’ve seen more patients request a C-section,” says Turicchi. “They’ll say, ‘I want to know when I’ll deliver. I have family members who are coming into town, and they want to know how to plan their time with me and when to arrive.’ ”
Randy Fiorentino, MD, is an OB-GYN physician at St. Joseph’s Hospital in Orange, California. Using tools provided by the California Maternal Quality Care Collaborative (CMQCC), his hospital has reduced its severe maternal morbidity rate to 1.4% and lowered its NTSV C-section rate by 11% between 2011 and 2017.
He says that when he talks to patients, he explains that recovering from a C-section isn’t the same as recovering from normal childbirth. That has to be kept in mind when talking to patients about the risk of this procedure, he says.
“C-sections in the U.S. have been on the rise for some time,” Fiorentino says. “We’ve been taking strides, at least in California, to greatly reduce our C-section rates, and we’ve been very, very successful. Particularly [at St. Joseph’s], C-sections aren’t just the delivery of a child, they’re major abdominal surgery. And when approached in that way, I believe greater care is taken by the physicians and the care team to optimize the maternal outcome.”