Reducing caesarean rates in a public maternity hospital by implementing a plan of action: a quality improvement report

BACKGROUND: Caesarean rates increased in different parts of the world, rising from 20% to 33% in the USA and from 40% to 55% in Brazil between 1996 and 2011; however, there was no reduction in morbimortality rates. Several factors have been suggested as responsible for this increase, such as health judicialisation, fear of the painful process on the patients’ part and reduction of medical training in vaginal delivery and labour complications. It is urgent to reverse this process and, therefore, a model of actions was created with the intention of engaging the team in order to reduce caesarean rates in a Brazilian hospital. METHODOLOGY: The model was based on the following actions: encouragement of labour analgesia; execution of written reports of any cardiotocographic examination; plan-do-study-act cycles for nursing orientations about the positions that favour pregnant women during labour; creation of a birth induction form; monthly feedback with physicians and nurses on caesarean rates achieved; verification of the caesarean rate by medical staff with individual feedback; daily round of medical coordination for case discussions; disclosure of caesarean rates on hospital posters; and constant dissemination of literature with strategies to reduce caesarean delivery. This plan of action started in January 2016. The mean caesarean section rate in the 31 months preceding the interventions (period A) was then compared with the 31 subsequent months (period B). RESULTS: Both periods presented caesarean rates with normal distribution. The mean caesarean rate was 29.24% (range: 38.69%–23.89%, SD 3.24%) vs 25.84% (range: 17.96%–34.97%, SD 3.92%, p<0.05), respectively, for periods A and B. CONCLUSION: After the implementation of the plan of action, there was a reduction in caesarean rates in this hospital.