Contra Costa Regional Medical Center (CCRMC) in Martinez has been honored for its perinatal program that helps more women who have had a cesarean delivery avoid the surgery with their next pregnancy.
CCRMC received the award earlier this month from the California Association of Public Hospitals and Health Systems and its quality improvement affiliate, the California Health Care Safety Net Institute. The award is given to a public hospital program that best represents an innovative approach to improving health care.
Historically, most medical providers advised women who have had a C-section not to attempt a non-surgical delivery because of the slight risk of a tear in the uterine wall during labor that can be dangerous to the mother and baby. However, in recent years established medical science has recognized that a vaginal birth after a cesarean (VBAC) is possible and preferable whenever it can be achieved safely, according to Judith Bliss, MD, chair of CCRMC’s Obstetrics and Gynecology Department.
“A non-surgical delivery carries less risk to mom and baby and allows them to bond more quickly. The key is being able to offer this option to women who’ve had a cesarean while ensuring the safest outcome possible,” Dr. Bliss said. “It’s a great joy to be able to offer many women this choice when they thought the option didn’t exist.”
The 166-bed county hospital is part of Contra Costa Health Services and about 15 percent of all babies born in Contra Costa County are delivered there. CCRMC’s perinatal unit was able to provide previous C-section patients with the VBAC option by developing a specific set of interventions, known as a “bundle,” to ensure staff could respond quickly to any complications that might occur during labor or delivery. The interventions include the ability to perform an emergency C-section, which should be started immediately in the unlikely event that a uterine rupture should occur.
Since initiating the program in October 2009, CCRMC has had significant success in reducing the percentage of repeat C-sections among eligible patients. This year, the average vaginal delivery rate for VBAC patients at CCRMC has averaged close to 90 percent through September; the national success rate for VBAC births ranges from 60 – 80 percent. CCRMC’s success rate has been attained with no long-term complications among patients who attempt a VBAC birth or to their babies, noted Dr. Bliss, who heads the team for the VBAC project.
CCRMC developed the VBAC program in close collaboration with the Institute for Healthcare Improvement, a not-for-profit organization based in Cambridge, Massachusetts that works with health care providers and leaders throughout the world to achieve safe and effective health care. "At a time when many providers have shied away from offering women the VBAC option because of the challenges involved, it's very gratifying to see this hospital make such a strong commitment to doing what it takes to give patients this opportunity," said Peter Cherouny, MD, chair of the Perinatal Improvement Community with IHI. "They're clearly putting their patients first and doing what's best for both mother and child."
“We know that there are times that we have no choice but to perform a C-section,” Dr. Bliss said. “But today women have the option of having a non-surgical delivery knowing every step has been taken to assure their safety and their baby’s. To see mom and newborn together right after the birth – skin-to-skin, breastfeeding, with their families nearby – lets us know that our efforts and our vigilance are paying off.”
Go here to see a video about CCRMC’s award-winning “Vaginal Birth after Cesarean (VBAC) Improvement Project.”