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Quality of Care Measures for Women During Pregnancy, Labor and Delivery

Several factors in the care of pregnant women are used as measures of the quality of care given during pregnancy, labor and delivery. These factors are:

• Timely screening for genetic and other conditions that may make a pregnancy, labor and delivery of a healthy baby more complicated or may affect the infant's condition at birth
• Pregnant women who are 35 years old or older at delivery and other women with a family history of genetic disorders may benefit from diagnostic screening such as sonograms, chorionic villus sampling (CVS) or amniocentesis.

  Chorionic villus sampling takes a small sample of placental tissue to examine for genetic abnormalities such as Down syndrome or chromosomal conditions. Amniocentesis takes a small sample of the fluid that surrounds a developing fetus (amniotic fluid) to look at for signs of genetic conditions such as Down syndrome, sickle-cell disease, cystic fibrosis and others.

• The percentage of women who are given a cesarean section during labor to deliver their babies
• The percentage of women who experience episiotomy (a deliberate surgical incision) or tears to the tissue around the vaginal area. A low percentage is better than a high one.
• The percentage of women who were given steroids before the birth of their preterm babies to help improve the outcomes for the infants. A high percentage is better than a low one.
• The amount of pain a woman giving birth to a baby experiences during labor and delivery
• The percentage of women who decide to breastfeed their babies and are supported by hospital resources
• Women's satisfaction with the care they received and their willingness to recommend a medical center to their family members and friends.

Quality of Care Given at the Cedars-Sinai Prenatal Diagnosis Center

Knowing as early as possible in a pregnancy whether a woman will have unusual risks during her pregnancy and delivery is important in helping the doctor provide the best and most appropriate care to protect both the mother's and the infant's health.

The following table reports patients' ratings of how easy it was to get an appointment at the Cedars-Sinai Prenatal Diagnosis Center.

Caring for Women Who Become Pregnant at 35 or Older

Women who have a baby when they are 35 or older are more likely to have complicated pregnancies. In addition, the risk factors for genetic conditions such as Down syndrome or other conditions increases as the mother gets older.

Knowing if - and what kind - of risk factors exist helps the obstetrician plan the care of an older pregnant woman. This helps assure the best outcomes for both mother and child during pregnancy, labor and delivery. The table below reflects the performance of the Cedars-Sinai Prenatal Diagnosis Center on measures of quality care for pregnant women who are age 35 or older.

* Noninvasive screening tests done during the first three month of pregnancy are measuring the fetus' neck (nuchal fold) and blood tests on the mother. Noninvasive screening tests during the second three months are genetic sonograms in cases where the mother refused invasive testing such as chorionic villus sampling or amniocentesis during the first or second three months of pregnancy respectively.

Safe and Effective Care Given During Labor and Delivery

When a woman delivers a baby vaginally there are fewer possible complications for both mother and child. In some circumstances, it is necessary to intervene with surgery by delivering the baby using a cesarean section.

If this occurs during a woman's first pregnancy, it is considered a primary cesarean delivery, and it puts the woman at increased risk for complications in future pregnancies (such as repeat cesarean delivery). Hence, a quality goal is to have a low percentage of first births by cesarean section (low primary cesarean rate).

Sometimes during labor and delivery, the obstetrician will do a surgical procedure called an episiotomy. The obstetrician makes an incision to widen the vaginal opening to make it easier for the baby's head to come through. At Cedars-Sinai, the goal is to have a low rate of episiotomies because they can increase the risk of nearby tissue tearing (third or fourth degree lacerations). Low percentages of these types of lacerations are an indicator of quality of care as the tearing can increase the risk of complications.

* Source: Joyce A. Martin, MPH; Brady E. Hamilton, PhD; Paul d. Sutton, PhD; Stephanie J. Ventura, MA; Fay Meanacker, Dr. PH; Sharon Kirmeyer, PhD; and Martha L. Munson, MS; Division of Vital Statistics, Births: Final Data for 2005. National Vital Statistics Reports 55(6): 2007 Dec 5.

** These data are from 2002 and are per 100 vaginal deliveries. Source: Graham, ID; Carrolli G; Davies, C; Medves, JM. Episiotomy Rates Around the World: An Update. Birth 32(3):219-23, 2005 Sep.

*** Source: The Joint Commission's qualitycheck.org for July 2006 through June 2007.

**** Source: Meadow WL. Bell A. Sunstein CR. "Statistics, Not Memories: What Was the Standard of Care for Administering Antenatal Steroids to Women in Preterm Labor Between 1985 and 2000?" Obstetrics & Gynecology. 102(2):356-62, 2003 Aug.

Pain Management During Labor

Fear of a painful labor and delivery can cause some women anxiety about giving birth. In managing labor pain, an obstetrician has to weigh the benefits of less pain and anxiety during labor with the effects of the various pain management options on the mother and the infant.

Sensitivity and reactions to pain are highly individual. An important measure of the quality of care a pregnant woman received is her perception of how well her labor pains were managed during delivery. The table below reports the responses of women who gave birth at Cedars-Sinai Medical Center on a survey about the quality of care they received. These responses are compared to the average responses of women surveyed by the more than 200 California hospitals participating in the California Hospital Assessment and Reporting Taskforce.

Breastfeeding of Newborn Babies

Breastfeeding provides a number of benefits to newborn babies, including:

• Providing the right kind and amount of nutrients for growing babies
• Helping protect the baby from many common diseases as well as protecting against allergies, asthma and eczema
• Aiding in healthy growth and development without the risk of gaining too much weight
• Enhancing the bonding between mother and child, and
• Speeding up the mother's recovery from delivery and pregnancy
  

Because of these benefits, a quality goal is to encourage and support women who want to breastfeed. The following table shows how many women initiated breastfeeding while at Cedars-Sinai Medical Center and how many women were exclusively breastfeeding at discharge.

Labor and Delivery Patient Satisfaction

Women who delivered babies at Cedars-Sinai Medical Center were asked two questions about their experience as patients at the Medical Center:

• Overall rating of the care they received. The women were asked to rate their experience on a 10-point scale, with 10 being "best hospital possible."
• Willingness to recommend the hospital to friends and family. Being willing to recommend a hospital to others is a strong indicator of a patient's satisfaction with her experience delivering a baby at that hospital.

The table below shows how women who delivered babies at Cedars-Sinai from July through September 2007 rated their experience at Cedars-Sinai. The table also shows how Cedars-Sinai's patient satisfaction ratings compare to the average patient satisfaction rating of other hospitals participating int he California Hospital Assessment and Reporting Taskforce.