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Strengthening the evidence base for maternal and child health programs

New: MCH Best strategies database for sample ESMs

Evidence Tools
MCH Best. NPM 2: Low-Risk Cesarean Delivery

MCH Best Logo pregnant woman reviewing a chart with a doctor

Strategy. Multicomponent: Active Management of Labor + Use of State/National Guidelines

Approach. Support providers in active management of labor using oxytocin infusion + develop state goal for low-risk cesarean section rate.

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Overview. Women attending a collaborative program of interdisciplinary maternity care (comprehensive, collaborative care from family physicians, midwives, community health nurses and doulas) were less likely to have a cesarean delivery.1

Evidence. Emerging. Adding population-based components to interventions may support the effectiveness of those interventions, as compared to interventions implemented in those categories alone. This strategy has been tested more than once and results trend positive overall. Access the peer-reviewed evidence on active management of labor through the MCH Digital Library. Access evidence related to use of state/national guidelines. (Read more about understanding evidence ratings).

Target Audience. Provider + state/national.

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 1 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 providers in active management of labor using oxytocin infusion + develop state goal for low-risk cesarean section rate,” 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):

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of women who deliver at a hospital identified as having initiatives in place to meet state goals for low-risk cesarean section rate over the next 8 years.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of women who deliver at a hospital identified as having initiatives in place to meet state goals for low-risk cesarean section rate over the next 8 years.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of women who received oxytocin in active labor and delivered vaginally at a hospital with initiatives in place to meet state goals for low-risk cesarean section rate over the next 8 years.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of women who received oxytocin in active labor and delivered vaginally at a hospital with initiatives in place to meet state goals for low-risk cesarean section rate over the next 8 years.

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):

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


Reference:

1 Harris SJ, Janssen PA, Saxell L, Carty EA, MacRae GS, Petersen KL. Effect of a collaborative interdisciplinary maternity care program on perinatal outcomes. CMAJ. 2012;184(17):1885-1892. doi:10.1503/cmaj.111753.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.