MCHbest. NPM 2: Low-Risk Cesarean Delivery
Strategy. Elective Induction Policy
Approach. Support the development of an elective induction policy.
Overview. Level of compliance with guidelines for induction of labor improved with successive rounds of audits leading to a reduction in cesarean section rates.1
Evidence. Emerging. Policies implemented at the hospital level appear most effective in decreasing the percentage of cesarean deliveries among low-risk first-time mothers. This strategy has been tested more than once and results trend positive overall. Access the peer-reviewed evidence through the MCH Digital Library. Access evidence specific to elective induction policies. (Read more about understanding evidence ratings).
Target Audience. Birthing hospitals.
Outcome. Reduction of primary cesarean delivery rates among nulliparous women. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the "Intervention Results" for each study.
Examples from the Field. There are currently 5 ESMs across all states/jurisdictions that use this strategy directly or intervention components that align with this strategy. Access descriptions of these ESMs through the MCH Digital Library. You can use these ESMs to see how other Title V agencies are addressing the NPM.
Sample ESMs. Using the approach “Support the development of an elective induction policy,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):
Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4):
1Haydar, A., Vial, Y., Baud, D., & Desseauve, D. (2017). Evolution of cesarean section rates Shoemaker, E. S., Bourgeault, I. L., Cameron, C., Graham, I. D., & Hutton, E. K. (2017). Results of implementation of a hospital‐based strategy to reduce cesarean delivery among low‐risk women in Canada. International Journal of Gynecology & Obstetrics, 139(2), 239-244.