Preventing Primary Cesarean Sections for First-time Mothers: Use of a Labor Dystocia Checklist

Abstract

In the United States, labor dystocia: or prolonged labor is the most common indication for a primary cesarean delivery for first-time mothers. Nulliparous, term, singleton, vertex presentation (NTSV) mothers experience variation in labor management. Cesarean sections are repeated for 90% of subsequent deliveries, and the risk of maternal and neonatal morbidity and mortality increases with each. At a Midwest community hospital, the cesarean section rate for NTSV mothers was about 30% from 2020-2022, above the national target of <23.6%. Additionally, 50% of NTSV cesarean sections in 2022 were indicated for labor dystocia. The purpose of this two-cohort, baseline and intervention group quality improvement project, was to determine if the use of a labor dystocia checklist, adapted from the American College of Obstetricians and Gynecologists and the Society for Maternal Fetal Medicine guidelines for safe labor management (2014), reduced NTSV cesarean section deliveries at a Midwest community hospital. Havelock’s Change Theory was used as a framework for the study. A convenience sample of NTSV mothers was used for the project (N = 750). The intervention occurred from November 2022-February 2023. The intervention group (n = 368) was compared to a baseline sample group from the immediately preceding four months (n = 382) for demographic likeness, delivery mode (primary outcome), and maternal and neonatal adverse outcomes (secondary outcome). A 2.3% decrease in NTSV cesarean section rates was noted for the intervention group without an increase in adverse maternal and newborn complications. The labor dystocia checklist is a safe, evidence-based, quality improvement intervention that can reduce unnecessary primary cesarean sections for first-time mothers.