MCH Best. NPM 2: Low-Risk Cesarean Delivery
Strategy. Multicomponent: Childbirth Education Classes + Active Management of Labor
Approach. Support the development of a statewide community-based childbirth education program + support providers in active management of labor using oxytocin infusion.
Overview. Several studies have looked at both components of this intervention together; emerging evidence trends positive for a combined effect. Studies of multicomponent interventions trend positive overall, showing a potential reinforcement of positive behavior change.1
Evidence. Emerging. Further evaluation is needed to understand how implementation of patient + provider specific interventions affect the proportion of cesarean deliveries among low-risk first births. Access the peer-reviewed evidence on childbirth education classes through the MCH Digital Library. Access the evidence related to active management of labor. (Read more about understanding evidence ratings).
Target Audience. Patients/providers.
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 XXX 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 a statewide community-based childbirth education program + support providers in active management of labor using oxytocin infusion,” 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):
1 Frigoletto FD, Lieberman E, Lang JM, et al. A clinical trial of active management of labor. N Engl J Med. 1995;333(12):745-750. doi:10.1056/nejm199509213331201.