Towards a more reliable measure of appropriate caesarean section use
Data access has been approved for a study to determine if the Normal Uncomplicated (NUD) rate, in conjunction with the Adverse Delivery Rate (AD), would provide a new, more reliable measure of the appropriateness of caesarean section use.
Cesarean section is a proven intervention to decrease mortality and morbidity for both babies and mothers, however, the last decade has seen a worldwide rise in the use of cesarean section and there are concerns about its impact on the quality of maternity care. The increase in the number of caesarean sections is attributed to changing demographics: increasingly mothers are older; give birth to bigger babies; and have multiple gestations - all of which are associated with increased use of cesarean section. There are also trends in maternity care that may be causative, including an increased use of cesarean section based on maternal choice. There is concern that this drift in practice is inconsistent with best practice, and increases health care costs.
“The need for a quality indicator to monitor the use of cesarean section is clear, but the cesarean section rate on its own is a poor measure,” says study lead, Dr. Geoff Cundiff, Head, Department of Obstetrics and Gynecology in the Faculty of Medicine at the University of British Columbia.
According to Dr. Cundiff, to establish a meaningful patient centered measure, a performance indicator for mode of delivery should begin by defining whether it was an uncomplicated delivery for mother and baby. In this context, an uncomplicated delivery is one that avoids the adverse events of labor.
“For babies an uncomplicated delivery is one without death, injury, depression at birth, hypoxemia, or other conditions requiring further medical care,” says Dr. Cundiff “And, as there are two patients in a delivery, an uncomplicated delivery must also avoid maternal death, injury, postpartum hemorrhage, and infection. Any of these outcomes, whether for mother or baby, denotes a delivery with adverse outcomes related to labour and delivery.”
The adverse outcomes used to define an uncomplicated versus adverse delivery are consistent with the Adverse Outcome Index (AOI), a consensus developed index that includes weighting of adverse events and a severity index. Dr. Cundiff’s previous work demonstrated that the AOI can be utilized in a population-based database to monitor trends in safety of labour and delivery over time and between hospitals.
PopData will link data from the BC Ministry of Health, BC Vital Statistics Agency and Perinatal Services BC for the project.