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School & Program Updates

South Florida: New FPQC Initiative Aims to Increase Vaginal Deliveries

The Florida Perinatal Quality Collaborative (FPQC) at the University of South Florida College of Public Health has launched a new statewide project aimed at reducing primary cesarean section deliveries in low-risk first-time mothers.

“This is an important maternal health issue for Florida mothers and babies as we have one of the highest cesarean rates in the nation,” said Dr. William Sappenfield, director of the FPQC and director of the Lawton and Rhea Chiles Center for Healthy Mothers and Babies in the department of community and family health.

Delivery by C-section has been increasing in Florida from a low of 21.9 percent in 1996 to a high of 38.1 percent in 2012; Florida’s provisional 2016 rate is 37.4 percent.

The U.S. has also seen a rise in the total C-section rate, while cerebral palsy and neonatal seizure rates have not changed since 1980.

While C-sections are essential for maternal and neonatal health, most experts agree that the current rates are too high.

The new quality improvement initiative is called the Promoting Primary Vaginal Deliveries Initiative (PROVIDE).

The project will include working with Florida stakeholders and hospitals to improve readiness, recognition, response and reporting, with the ultimate goal of promoting intended primary vaginal deliveries.

The goal of PROVIDE is to improve maternal and newborn outcomes by applying evidence-based interventions to promote primary vaginal births at Florida delivery hospitals and ultimately reduce Nulliparous, Term, Singleton, Vertex (NTSV) cesareans.

NTSV represents babies born at or beyond 37 weeks gestation to women in their first pregnancy that are singleton (no twins or beyond) and in the vertex presentation (no breech or transverse positions), via cesarean birth.

It is likely NTSV cesareans are driving the increasing cesarean rate as virtually all subsequent births by NTSV women will be delivered by cesarean due to limited opportunity for vaginal delivery after cesarean.

In 2014, the national rate of primary cesareans was 26 percent; in Florida, it was 31 percent, the second highest in the U.S.

Funding for PROVIDE is provided by the Florida Department of Health’s Title V Block Grant, and the National Alliance for Innovation on Maternal Health (AIM) Program.

Forty-five participating hospitals across the state will utilize a variety of quality improvement techniques and processes to address focus areas identified as a priority by their facility.

At the ‘Initiative Kick-Off’ meeting, held Oct. 5, 185 hospital champions were educated on the background and significance of the issue, as well as an overview of the key drivers for cesarean delivery and key recommendations.

[Photo: Health care providers were energized about the new PROVIDE initiative. (Photo courtesy of Emily Bronson)]

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