MCH Best. NPM 2: Low-Risk Cesarean Delivery
Strategy. Nutrition Education for Expectant Mothers
Approach. Provide educational materials or trainings that increase awareness and identify risk factors for nutrition-related indicators that have been shown to increase cesarean deliveries.
Overview. Women who enter pregnancy at a healthy body mass index (BMI); maintain healthy pregnancy weight and experience appropriate weight gain during pregnancy; and are screened and treated for gestational diabetes mellitius (GDM), hypertension, and pre-existing diabetes are shown to experience low-risk first births through non-cesarean, vaginal delivery.1
Evidence. Emerging. Multiple studies have shown that weight and associated health issues affect the decision for cesarean delivery: increasing BMI;2 pregnancy weight and weight gain, independent of birth weight;3,4 gestational diabetes mellitus (GDM);5 hypertension;6 and pre-existing diabetes7 have all been associated with increased risk for cesarean delivery. (Read more about understanding evidence ratings). Preconception education interventions, including nutrition interventions, have been identified by Robert Wood Johnson Foundation's What Works For Health as having some evidence for improved outcomes.
Target Audience. Patients.
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 in the references and read the "Intervention Results" for each study.
Examples from the Field. There are currently no ESMs across all states/jurisdictions that use this strategy directly; however several states use 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 “Provide educational materials or trainings that increase awareness and identify risk factors for nutrition-related indicators that have been shown to increase cesarean deliveries,” 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 Association of State Public Health Nutritionists. (2016). Incorporating Nutrition into the Title V MCH Services Block Grant National Performance Measures. [Health Resources and Services Administration, Maternal and Child Health Bureau Funded Issue Brief].
2 Berendzen JA, Howard BC. Association between cesarean delivery rate and body mass index. Tenn Med. 2013;106(1):35-42.
3 Witter FR, Caulfield LE, Stoltzfus RJ. Influence of maternal anthropometric status and birth weight on the risk of cesarean delivery. Obstet Gynecol. 1995;85(6):947-951. doi:10.1016/0029-7844(95)00082-3
4 Graham LE, Brunner Huber LR, Thompson ME, Ersek JL. Does amount of weight gain during pregnancy modify the association between obesity and cesarean section delivery?. Birth. 2014;41(1):93-99. doi:10.1111/birt.12095
5 Moyer VA; U.S. Preventive Services Task Force. Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160(6):414-420. doi:10.7326/M13-2905
6 Bramham K, Parnell B, Nelson-Piercy C, Seed PT, Poston L. Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis. BMJ 2014; 348.
7 Kitzmiller JL, Block JM, Brown FM, et al. Managing preexisting diabetes for pregnancy: summary of evidence and consensus recommendations for care. Diabetes Care. 2008;31(5):1060-1079. doi:10.2337/dc08-9020