MCHbest. NPM 2: Low-Risk Cesarean Delivery
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.
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):
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 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.