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

More than 6,000 deliveries are performed at Cedars-Sinai Medical Center annually.  The Department of Obstetrics and Gynecology at Cedars-Sinai is dedicated to providing high quality patient care, and tracks a number of measures to support this effort.  A limited set of quality data is submitted to The Joint Commission on a quarterly basis and made available to the public.  To view the most current information submitted to The Joint Commission, click here.  Performance across additional measures tracked by Cedars-Sinai are shared below.

These measures include:

Safe and Effective Care Given During Labor and Delivery

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 Care Cedars-Sinai 2015 Nationally
Number of women having their first cesarean section among all women who did not have a prior cesarean section (primary cesarean rate).* 23.4% 25.9%1
Total number of women having a cesarean (either a primary or a repeat cesarean) 33.2% 32.8%2
Percentage of women who successfully deliver vaginally after having once had a cesarean (VBAC) 12.2% 9.2%2
Percentage of women who have an episiotomy during delivery.
A low number is better than a higher one.
1.7% 30-35%3
Percentage of women who have a severe vaginal or rectal laceration (tear). These are known as third or fourth degree lacerations. 2.3% 3.25%


1Source:  The Joint Commission Annual Report on Quality and Safety 2014.
 
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

 

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.

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.