Leading Change on Labor and Delivery: Reducing Nulliparous Term Singleton Vertex (NTSV) Cesarean Rates

摘要

It is easy to get into a rut in life. Unfortunately, this seems to be the pattern in many American maternity units. During the last several decades, rates of interventions-in particular labor inductions and cesarean births-have steadily increased without evidence of maternal or neonatal benefit. External scrutiny of maternity practices dwindled, giving the impression to providers that procedure rates did not matter. External pressures grew, including changing payment models emphasizing the office as the major source of revenue and recurrent back-of-the-mind worries for liability exposure. In this new environment, a culture developed in many labor and delivery units that seemed to de-emphasize and even devalue normal labor and birth. In spite of numerous editorials along the way decrying the rise in cesarean rates, little changed until a recent growing consensus emerged that there is a better way to support birth.