Community Hospital Lowers C-Section Rate to 11%.

KAMUELA, HAWAII -- Ten willing obstetricians and a supportive nursing staff reduced the cesarean section rate at their community hospital from 16.59% to 10.92% over a 10-year period by implementing active management of labor guidelines, reported Dr. John Naiden of Yakima Valley Memorial Hospital, Yakima, Wash.

The physicians drew their inspiration from Dublin, Ireland, obstetrician Kieran O'Driscoll, who in the mid-1980s published studies citing a cesarean rate of less than 5%, without sacrificing perinatal outcomes.

"We did not have any fixed idea of what our appropriate c-section rate would be, but we thought we could get it to 10%," Dr. Naiden said at the annual meeting of the Pacific Coast Obstetrical and Gynecological Society. "We made a commitment, and we said, let's do it."

A review of the literature produced agreement among the private physicians to follow a labor protocol beginning in 1989 that called for augmentation with oxytocin (1-2 mU every 15 minutes up to 20 mU) if dilatation did not progress at least 1 cm/hr in the first stage of labor. "We tried to make VBAC [vaginal birth after cesarean] the standard of care," he said.

Breech births were encouraged in most cases when external version failed, and postdates gestations were discouraged, since both circumstances are associated with increased cesarean rates.

Dr. Naiden explained that his 300-bed hospital draws from a 40- to 50-mile referral area and houses a level III nursery and a regional perinatal program for high-risk patients. The 2,500 deliveries at the hospital each year represent about half of the deliveries in the referral area, which contains several smaller hospitals. Transport to the nearest major city, Seattle, is frequently impossible when weather fronts move into the Cascade Mountains, which separate central Washington ...