Presentation Information

Reducing Cesarean Rates Through Teamwork and Innovation: A Case Study From Denmark

• Speaker: Kamilla Gerhard Nielsen , MD
• Presentation Type:
• Duration: 60 Mins
• Credits: 1 CERP, 1 ACM CPD, 1 ACNM CEU, 0.1 Midwifery CEU

Abstract:

The cesarean delivery rate in America has increased steadily from 5% to 30-32% over the last 50 years, along with an increase in costs as well as short- and long-term maternal, neonatal and childhood complications. In Denmark, extensive teamwork between obstetricians and midwives has succeeded in reducing the cesarean section rate at the Hospital of Southern Jutland (SHS). Ten initiatives were implemented over eight years from 2010 to 2018. The department focused on natural childbirth, teamwork, vaginal breech birth, VBAC and only performing cesarean section (CS) when medically indicated.

After implementation of the initiatives at SHS the rate of elective CS decreased from 8% to 3%, emergency CS stable at 13%, and the overall CS rate decreased from 20% to 16% in 2021. In comparison the national rate went from 21% to 19%.

These reductions were made without any significant increase in birth complications such as instrumentation at vaginal delivery, low pH or low Apgar scores. One of the biggest changes at SHS is the rate of vaginal birth after previous cesarean section. The department has a team working to support women with fear of childbirth by making specific birthing plans. The department shares a belief that a good vaginal birth experience is better than an elective cesarean if the women feels safe.