Skip Navigation

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 Deliveries

MCH Best Logo

pregnant woman reviewing a chart with a doctorMulticomponent: Chart Audit and Feedback + State/National Guidelines

MCH Strategy. Support the development of an elective induction policy + develop state goal for low-risk cesarean section rate.

Return to main MCH Best page >>

Overview. After adopting guidelines from the Consensus for the Prevention of the Primary Cesarean Delivery, the cesarean delivery rate among nulliparous women was substantially reduced.1

Evidence. Emerging Evidence. 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 for chart audit and feedback through the MCH Digital Library. Access evidence for state/national guidelines. (Read more about understanding evidence ratings).

Target Audience. Hospital + 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 6 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 strategy “Support the development of an elective induction policy + 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 hospitals in the state utilizing the elective induction policy as best-practice that have been identified as having initiatives to meet state goal for low-risk cesarean section rate over the next 5 years.

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

  • Percent of hospitals in the state utilizing the elective induction policy as best-practice that have been identified as having initiatives to meet state goal for low-risk cesarean section rate over the next 5 years.

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

  • Number of hospitals that are using the elective induction policy and are compliant with the policy guidelines based on chart audit and review that have met the goal for low-risk cesarean section rate by 5 years.

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

  • Percent of hospitals that are using the elective induction policy and are compliant with the policy guidelines based on chart audit and review that have met the goal for low-risk cesarean section rate by 5 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 Wilson-Leedy JG, DiSilvestro AJ, Repke JT, Pauli JM. Reduction in the cesarean delivery rate after obstetric care consensus guideline implementation. Obstet Gynecol.2016;128(1):145-152. doi:10.1097/aog.0000000000001488.

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.