Quality of Care Measures for Women During Pregnancy, Labor and Delivery

The Department of Obstetrics and Gynecology at Cedars-Sinai is dedicated to providing high quality patient care . A variety of measures of quality of care are monitored continuously at Cedars-Sinai.

These measures include:

Safe and Effective Care Given During Labor and Delivery

More than 6,000 deliveries are performed at Cedars-Sinai Medical Center annually.

When a woman delivers a baby vaginally there are fewer possible complications for both mother and child. In some circumstances, it is necessary to intervene with surgery by delivering the baby using a cesarean section.

If this occurs during a woman's first pregnancy, it is considered a primary cesarean delivery, and it puts the woman at increased risk for complications in future pregnancies (such as repeat cesarean delivery). Hence, a quality goal is to have a low percentage of first births by cesarean section (low primary cesarean rate).

Sometimes during labor and delivery, the obstetrician will do a surgical procedure called an episiotomy. The obstetrician makes an incision to widen the vaginal opening to make it easier for the baby's head to come through. At Cedars-Sinai, the goal is to have a low rate of episiotomies because they can increase the risk of nearby tissue tearing (third or fourth degree lacerations). Low percentages of these types of lacerations are an indicator of quality of care as the tearing can increase the risk of complications.
 

Quality Measures for Delivery CareCedars-Sinai 2013Nationally
Number of women having their first cesarean section among all women who did not have a prior cesarean section (primary cesarean rate).*25.7%23.6%1
Total number of women having a cesarean (either a primary or a repeat cesarean)34.7%32.8%2
Percentage of women who successfully deliver vaginally after having once had a cesarean (VBAC)13.0%9.2%2
Percentage of women who have an episiotomy during delivery.
A low number is better than a higher one.
2.3%30-35%3
Percentage of women who have a severe vaginal or rectal laceration (tear). These are known as third or fourth degree lacerations.2.7%3.25%
Percentage of women who deliver premature babies (after 24 to 34 weeks of pregnancy), who were given steroids before the birth to improve the outcomes for the infant.  
A high percentage is better than a lower one.
94.8%73.6%4
Percentage of women who have elective deliveries before 39 weeks.
A low number is better than a higher one.
2.4%4.6%5


1Source:  Martin JA, Hamilton BE, Ventura SJ, et al. Births: Final data for 2010. National vital statistics reports; vol 61 no 1. Hyattsville, MD: National Center for Health Statistics. 2012.
 
2 The Childbirth Connection. Rates for Total Cesarean Section, Primary Cesarean Section, and Vaginal Birth After Cesarean (VBAC), United States, 1989- 2010

3Source:  Hartmann K, Viswanathan M, Palmieri R, Gartlehner G, Thorp J, Lohr KN. Outcomes of Routine Episiotomy: A Systematic Review. JAMA. 2005;293(17):2141-2148. doi:10.1001/jama.293.17.2141 

4Source:. Improving America’s Hospitals: The Joint Commission’s Annual Report on Quality and Safety 2012 (pg 33)

5Source:. The Leapfrog Group

Pain Management During Labor

Fear of a painful labor and delivery can cause some women anxiety about giving birth. In managing labor pain, an obstetrician has to weigh the benefits of less pain and anxiety during labor with the effects of the various pain management options on the mother and the infant.

Sensitivity and reactions to pain are highly individual.  An important measure of the quality of care a pregnant woman received is her perception of how well her labor pains were managed during delivery. The chart below compares the responses of women who gave birth at Cedars-Sinai Medical Center on a survey about the quality of care they received with the average responses of women surveyed by the Picker Institute.

The chart below compares the percentage of Cedars-Sinai patients who stated that they had the right amount of pain medicine compared to percentage of women delivering babies nationally, based on Picker scores.

 

Promoting and Supporting Breastfeeding

Breastfeeding results in improved infant and maternal health outcomes1.  The longer a baby is exclusively breastfed, the greater the protection.  This includes:

  • A decreased risk of respiratory infections, ear infections, and gastrointestinal infections.
  • A reduced risk of asthma, allergies including atopic dermatitis, and celiac disease.
  • A reduction in the incidence of type 1 and type 2 diabetes.
  • Significantly lower rates of obesity in infants who are breastfed.
  • A reduction in childhood leukemia and lymphoma correlated to length of breastfeeding.

Mothers also enjoy short- and long-term health benefits including:

  • Decreased postpartum blood loss and a more rapid return to her pre-pregnant state.
  • Reduced risk of rheumatoid arthritis, adult cardiovascular disease, diabetes, premenopausal breast cancer, and ovarian cancer.The longer a woman breastfeeds, the greater the reduction in the above diseases.

Because of these benefits, a national quality goal is to encourage and support women who want to breastfeed. Healthy People 2020, a national initiative to reduce preventable threats to Americans' health, has set a national goal of having 81.9% of women breastfeed their babies soon after birth.

The following table shows how many women initiated breastfeeding while at Cedars-Sinai Medical Center and how many women were exclusively breastfeeding at discharge. 

Initiation of breastfeeding at Cedars-Sinai consistently exceeds the national goals of 81.9% as established by the Healthy People 2020 Initiative.

In-Hospital Breastfeeding Rates2Jan-Mar 2013Apr-June 2013Jul-Sep 2013Oct-Dec 2013
Percentage of women who initiated breastfeeding during hospital stay97%98%97%98%
Percentage of women who were exclusively breastfeeding at discharge74%74%73%75%

 

1Eidelman AI, Schanler RJ, et al; American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk.  Pediatrics. 2012; 129:e827-e841

Excludes babies who were discharged from the Neonatal Intensive Care Unit, and other specific conditions. We use the exclusions developed by The Joint Commission, a national organization whose mission is "to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value."

Labor and Delivery Patient Satisfaction

Women who delivered babies at Cedars-Sinai Medical Center were asked two questions about their experience as patients at the Medical Center:

  • Overall rating of the care they received. The women were asked to rate their experience on a 10-point scale, with 10 being "best hospital possible."
  • Willingness to recommend the hospital. The women were asked to rank the hospital on a 10-point scale, with 10 being "best hospital possible."

The chart below shows the percentage of women who rated the care they received during labor and delivery as 9 or 10.  

 

The chart below shows patient rankings of Cedars-Sinai Medical Center for obstetrical care compared to patient rankings nationwide.

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