Sharp Grossmont leads the way to lower C-section rates

Of the roughly 500,000 babies born in California every year, one-third are born via cesarean delivery, or C-section, although individual hospitals rates vary. Nationwide, C-section rates can run as high as 50 percent.

In certain instances, a C-section may be medically necessary - even lifesaving - but there are also serious risks involved. Doctors typically recommend the procedure because there may be a high-risk complication making a vaginal birth unsafe.

However, C-section rates are growing, with little evidence that the increase is resulting in better outcomes for moms and babies. The federal government took note and gave all U.S. hospitals a target to not to exceed a 23.9 percent C-section rate - for first-time mothers with low-risk pregnancies - by 2020.

Sharp Grossmont Hospital has worked diligently to lower its rates and received national recognition earning a spot on the 2024 U.S. News & World Report Best Hospitals for Maternity Care list, as well as last year's 2022-23 list, for high-quality labor and delivery services. This includes exceeding quality measures such as low C-section rates. They were also named to Newsweek's Best Maternity Hospitals 2021 list. The distinction recognizes U.S. hospitals that have excelled in providing safe, high-quality care for mothers and newborns and C-section rates that surpass the federal target aimed at reducing rates for first-time mothers with low-risk pregnancies.

In addition, the hospital was honored by the California Health and Human Services Agency, which issues an annual C-section honor roll recognizing hospitals that also meet or surpass the federal target. According to Lisa DeLong, perinatal educator, Sharp Grossmont's labor and delivery team has made low C-section rates a priority. "Our rates have decreased from 32.5% in 2014 to 20.3% in 2020." she says.

DeLong goes on to explain more about C-section rates and why they matter:

Why have C-section rates increased in recent years?

Between 1998 and 2008, C-section births rose from 22 to 33 percent, making it the most commonly performed surgical procedure in the U.S. The increase may partially be due to a growing high-risk population - patients with diabetes, high blood pressure, obesity and advanced maternal age. There is also great variation between regions, hospitals and providers. This variation suggests there are opportunities for improvement in practice.

When should a C-section be considered? And what are the risks?

Multiple births, placental complications, fetal distress or when the baby is too big to fit through the birth canal are all possible reasons to have a C-section. Although a C-section can be lifesaving, it carries increased risk for bleeding, infection and potential psychological stress. C-section birth is also associated with increased pain and fatigue, longer hospital stays, longer recovery times, and decreased breastfeeding success. 

Subsequent pregnancies may also be affected; once a patient has had their first C-section, the risk of a future C-section increases by 90 percent, and the risk of uterine rupture and placental abnormalities increases as well. That's why it's important to prevent the first C-section to promote quality outcomes for the future.

What steps has Sharp Grossmont taken to lower its C-section rates?

The Labor and Delivery team at Sharp Grossmont undertook a multidisciplinary approach with patient safety as a priority. A task force was formed, including obstetricians, nurses and administrative leaders who championed evidence-based strategies to promote vaginal birth.

A labor positioning handbook was created for Labor and Delivery team members, which advocates for:

• Frequent position changes during labor

• Patient mobility during labor, including walking

• Use of a peanut ball - a peanut-shaped exercise ball known to help shorten labor

Focus was also placed on education, the creation of guidelines and the development of checklists to help patients, doctors and nurses make informed choices.

Why is it significant that Sharp Grossmont was honored by U.S. News & World Report and Newsweek, and placed on the C-section honor roll?

U.S. News & World Report is considered one of the global authorities in hospital rankings and consumer advice. Sharp Grossmont was ranked as a “high performing” maternity hospital, the highest designation a hospital can receive. U.S. News & World Report compared maternity and prenatal care data recognizing hospitals for uncomplicated pregnancies including low C-section rates in lower-risk pregnancies, low newborn complication rates, exclusive breast milk feeding rates, and low early elective delivery rates, among other criteria that can lead to better outcomes. The list is also considered an evaluation tool to help expectant parents, in consultation with their doctors, in making informed decisions about where to receive top maternity care.

Newsweek also recognized Sharp Grossmont for its efforts to maintain low C-section rates, among other best practices. Newsweek partnered with The Leapfrog Group, a national nonprofit organization that reports on the safety and quality performance of U.S. health care facilities. Hospitals must meet tough standards for excellence in maternity care to make the cut, including hospitals that have low rates of C-section, episiotomy, and early elective deliveries, and follow important protocols to protect moms and babies. Though these are standards aligned with medical research and best practices, not all hospitals achieve them. Newsweek's Best Maternity Care Hospitals are an elite group demonstrating the highest performance in the U.S.

Sharp Grossmont has further demonstrated its commitment to provide a safe environment for moms-to-be by earning a place on the California Health and Human Services Agency C-section honor roll from 2015-19, and again in 2022. The agency collaborates with Smart Care California, a public-private partnership working to promote safe and affordable health care, and the California Maternal Quality Care Collaborative, a multi-stakeholder organization committed to ending preventable morbidity, mortality and racial disparities in care. Every year, they publish a C-section honor roll which honors hospitals that meet or surpass the federal benchmark.

For the news media: To talk with Lisa DeLong about Sharp Grossmont Hospital's work to lower C-section rates for an upcoming story, contact Erica Carlson, senior public relations specialist, at erica.carlson@sharp.com.