Culture Change and Decreased Cesarean Rate Through Implementing C.A.L.M. [35O]

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In 2015, by putting the ACOG Consensus into practice, our institution was able to reduce our nulliparous, term, singleton, vertex (NTSV) cesarean rate by 5%. Our numbers then plateaued throughout 2016. In a continued effort to reduce the rate of cesarean sections amongst NTSV patients, we have instituted a multidisciplinary committee within our community hospital setting to help create a Consistent Approach to Labor Management (CALM). At the start of this project, our NTSV cesarean rate was 31.6%. Our benchmark goal was set at less than 24%.


The NTSV committee established four work groups with inspiration from the California Maternal Quality Care Collaborative (CMQCC) initiatives that included latent labor interventions, comfort measures for labor, second stage interventions, and ambulation in labor. Each work group focused on identifying variables that have an impact on the rates of cesarean section. An NTSV Fair was held to educate all staff and physicians. NTSV numbers were tracked and shared with all physicians in an unblinded, quarterly basis.


Over an eight-month period we have been able to reduce our NTSV cesarean rate from 31.6% to 24.4%.


The Consistent Approach to Labor Management (CALM) Project has helped us to nearly reach our benchmark goal for NTSV cesarean rates. Our NTSV committee will continue to educate our staff and physicians as we strive to change the overall culture towards supporting vaginal deliveries.

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