Holistic caregiving is among the most important aspects of proper clinical care hence the need to always maintain it at an optimum level. Optimization includes constantly improving the best standards, hence the concept of Quality Improvement (QI) in the practice of nursing. Under QI, professionals learn from past practice and combine it with available research in order to keep on improving systems and policies. Among the critical areas of QI that affects the quality of care in nursing is the reduction of cesarean section (CS) births in American hospitals (Kingdom, Downe & Betran, 2018). Approximately 33% of all births in America happen through CS. However, some hospitals have a ratio of CS births that is as low as below 20% while others have higher than 50% which amounts to a massive difference in ratios. From the perspective of care, CS births are more disadvantageous both to the mother and to the child. It is on this basis that QI to reduce the ratio of CS births in any hospital is critical. In the instant research paper, the QI issue of reduction of CS births will be evaluated based on a case study on the Monterey Park Hospital in Los Angeles, California.
Monterey Park Hospital Institutional Policy on CS Births
Whereas Monterey Park Hospital does not have an express policy on CS section, available statistics and commentary provide an avenue for the assessment of the general hospital policy on the subject. According to Keehn (2016), the hospital has a 41.6% rate of CS births. The exponentially high rate means that there is almost one CS birth for every two average births that happen at the hospital. Further, as per Keehn (2016), Monterey Part did not make any response when an inquiry was made about their CS birth rates and whether they intend to reduce them. By comparison, Sutter Davis Hospital has a CS birth rate of 12% while Bakersfield Memorial Hospital has a rate of 15%. Based on the above, it would be correct to arrive at a conclusion that the policy at Monterey Park Hospital is to encourage, rather than seek to reduce the rates of CS births at the hospital.
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The Gap between QI Issue of CS Rate Reduction and Institutional Policy
The approach undertaken by Monterey Park Hospital, as indicated above, flies in the face of the standard approach engendered in the QI issue of CS rate reduction. The assessment is based on the fact that the general rate in the USA is approximately 33% and the hospital of focus herein is way above that average. Further, as reflected above, the CS rate at the hospital is almost four times higher than some of the hospitals within the same state of California. Monterey hospital, therefore, would be a viable candidate to adopt the QI on the issue of CS rate reduction as it urgently and effectively needs to arrest its runaway CS rates. A proper QI approach would reduce the CS rates gradually, in the very least to the level of the national average rates.
Those at Risk
Based on available research and commentary, CS births pose a health risk both to the mother and the child. Other than the risk, the process of CS birth and the subsequence convalescence is more expensive than that of virginal births. Further, with regard to the mother, a CS birth increase the risk of injury during the process of delivery. CS births involve a major surgery which in the first place will require the mother to be placed under anesthesia (Nierenberg, 2018). Any time a patient is put under anesthesia, there is always a risk of complications, inter alia through an allergic reaction to the drugs used. Secondly, in the process of a CS birth, there is always a risk that some organs may be adversely affected by the process since it involved an incision into the cavity of the mother’s belly (Nierenberg, 2018). There is also a higher propensity for infection during the process of birth and even later through the incision made. After birth, a mother who has delivered through CS is more likely to take longer to heal than those who have vaginal births. The longer healing period increases the physical pain and psychological impact of the birth (Visser, 2015). Finally, CS births increase the chances of a uterine tear during a subsequent pregnancy and also reduces the chances of a vaginal birth in the future. From the perspective of the child, a CS birth creates a risk that the baby may be injured in the process of delivery. A CS birth also denies the child a chance to have the fluids in the lungs squeezed out as happens in a vaginal birth, thus increasing the propensity for breathing problems. The CS process also increases immediate recovery time, thus delaying the first contact between mother and baby and also the first time the baby breastfeeds (Visser, 2015).
QI Approach to Improvement
The solution for the above problem is to develop a viable and effective QI process for the reduction of incidences of CS births. There are three different ways in which a decision for CS births is arrived at, each of which needs to be factored in the QI process. The first is elective CS where the mother makes a choice to undergo a CS birth for personal, not clinical reasons. In this aspect, counseling can be an effective mitigation approach. Prospective mothers who approach the hospital seeking for elective CS births can be enlightened on the dangers of CS births and the benefits of vaginal births so that they can make a more informed decision (Kingdom, Downe & Betran, 2018). The second way is the clinically adviced or recommended CS birth where for a variety of reasons, a clinical advices a mother to have a CS birth as opposed to a normal vaginal birth. The decision may be based on a variety of factors including the size of the baby, weakness of the mother or fear that the child may get an infection inside the birth canal. In this avenue, mitigation can be made by developing a policy where mothers are only advised to undergo CS section after proper vetting. During the vetting process, a benefit of the doubt should be extended to the vaginal birth. The third and final way that a CS section may be arrived at is through an emergency decision, where CS had not been planned but is deemed necessary. Mitigation under this avenue is low, but a policy where every benefit of the doubt is extended to a vaginal birth can be implemented (Kingdom, Downe & Betran, 2018). If all the three approaches above are adopted, Monterey Park Hospital can exponentially reduce CS rates.
Conclusion
As part of the care process, it is important to provide the best chance for the child while coming into the world and also the best condition for the mother. Based on the research and analysis above, opting for a vaginal birth, as opposed to a CS birth provides a better chance to both mother and child from a health perspective. It is on this basis that any hospital with an inordinately high CS birth rate, such as the Monterey Park Hospital should consider a QI process for the reduction of the rates. As reflected by the research above, A CS birth increases the propensity for injury for both mother and child. It also delays both the first physical meeting between mother and child and the first instance of breastfeeding. There are three main ways that a CS birth decision is arrived at. As outlined above, each of the three ways can be incorporated into the CS reduction QI, so as to increase the propensity for vaginal births to the benefit of both mother and child.
References
Keehn, J. (2016). California hospitals to avoid if you don't want a C-section. Retrieved from https://www.consumerreports.org/doctors-hospitals/california-hospitals-to-avoid-if-you-dont-want-a-c-section/
Kingdon, C., Downe, S., & Betran, A. P. (2018). Non-clinical interventions to reduce unnecessary caesarean section targeted at organisations, facilities and systems: Systematic review of qualitative studies. PloS One , 13 (9), e0203274.
Nierenberg, C. (2018, March 26). Vaginal birth vs. C-section: Pros & cons. Retrieved from https://www.livescience.com/45681-vaginal-birth-vs-c-section.html
Visser, G. H. (2015). Women are designed to deliver vaginally and not by cesarean section: An obstetrician's view. Neonatology , 107 (1), 8-13
