Award Date

5-1-2012

Degree Type

Dissertation

Degree Name

Doctor of Nursing (ND)

Department

Nursing

First Committee Member

Mary Bondmass

Second Committee Member

Patricia Smyers

Third Committee Member

Sheniz Moonie

Number of Pages

70

Abstract

The Centers for Disease Control and Prevention's National Center for Health Statistics (2010) report that nearly one-third of babies were born by Cesarean section (CS) in 2007. Of interest, six states, including Nevada, experienced increases of more than 70% in the last 10 years (CDC, 2007). Based on the increased rate of CS deliveries, the National Institutes of Health (NIH) convened a consensus panel in 2010, which urged the medical community to reduce barriers to women who want to try a vaginal birth after Cesarean delivery (VBAC) in the hope this would safely decrease the total CS rate. For clinicians and patients, outcomes research provides evidence about benefits, risks, and results of treatments so they can make more informed decisions. Utilization and inpatient quality indicators examine procedures whose use varies significantly across hospitals and for which questions arise about overuse, underuse, or misuse (AHRQ, 2006). Experts examine Cesarean delivery and VBAC rates because safety and quality and appropriate use of limited medical resources may be compromised with the current and further increase of CS rates. The AHRQ states that VBAC may be an underused procedure (AHRQ, 2006). Maternity safety and quality are key underlying elements to the significance of this capstone. Available data indicate that CS delivery is the most common operative procedure performed in the United States and is associated with higher costs than vaginal delivery and increased maternal morbidity (AHRQ, 2007; Smaill & Gyte, 2010). Although current practice guidelines exist with the recommendation to offer VBAC to selected clients, there is increasing evidence that VBAC rates are decreasing (CDC, 2010), especially in Nevada with Southern Nevada specifically composing the majority of the State's population. Therefore, the primary purpose of this capstone was to conduct a pilot study to examine CS and VBAC practices in Southern Nevada and to further determine if there are provider variations in CS and VBAC practices in the nearby regional areas to Southern Nevada including Tucson, Arizona, Salt Lake City, Utah, San Diego, California, and Reno, Nevada. A descriptive survey design was used for this study with participant recruitment targeted toward physicians and nurse-midwives who provide prenatal care and perform newborn deliveries in the hospital. Results indicate that there is a significant variation in regional providers related to CS and VBAC in that in Southern Nevada, providers perform more CS and offer less VBAC than in the regions compared; Salt Lake City providers performed the least CS and offered VBAC most often.

Despite a relatively low response rate in this study, for this sample, there were significant differences found and these differences suggest safety and quality concerns related to maternity care in Southern Nevada. Based on these data, a more formalized and rigorous study, utilizing experienced researchers and clinicians is warranted and recommended.

Keywords

Cesarean section; Maternal health services; Medical care – Quality control; Provider practices; Quality indicators; Utilization indicators; Vaginal birth after cesarean; VBAC

Disciplines

Maternal, Child Health and Neonatal Nursing | Nursing | Nursing Midwifery | Obstetrics and Gynecology

Language

English


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