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

The Department of Obstetrics and Gynecology at Cedars-Sinai is dedicated to providing high quality patient care. A variety of measures of quality of care are monitored continuously at Cedars-Sinai.

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 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.

Caring for Women at Risk for Genetic Disorders

Knowing if -- and what kind -- of risk factors exist helps the obstetrician plan the care of a pregnant woman and her newborn. 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 referred for concerns about genetic disorders (including women age 35 or older).

* Noninvasive screening tests done during the first three months of pregnancy are measuring the fetus' neck (nuchal fold) and blood tests on the moth.  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

More than 6,000 deliveries are performed at Cedars-Sinai Medical Center annually.

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.

¹Source: by Brady E. Hamilton, Ph.D.; Joyce A. Martin, M.P.H.; Stephanie J. Ventura, M.A.; Division of Vital Statistics, Births: Preliminary data for 2009. National Vital Statistics Reports 59(3): 2010 Dec 21. 

²Division of Urogynecology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA.; Am J Obstet Gynecol. 2009 Feb 23 

³Source: The Joint Commission's qualitycheck.org for July 2007 through June 2008. 

⁴Source: The Joint Commission qualitycheck.org for Oct. 2009 through Sept. 2010

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 chart below compares the responses of women who gave birth at Cedars-Sinai Medical Center on a survey about the quality of care they received with the average responses of women surveyed by the Picker Institute.

The chart below compares the percentage of Cedars-Sinai patients who stated that they had the right amount of pain medicine compared to percentage of women delivering babies nationally, based on Picker scores.

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. Healthy People 2010, a national initiative to reduce preventable threats to Americans' health, has set a goal of having 75% of women breastfeeding their babies soon after birth.

The following table shows how many women initiated breastfeeding while at Cedars-Sinai Medical Center and how many women were exclusively breastfeeding at discharge. Breastfeeding rates at Cedars-Sinai consistently exceed the targets set in the Healthy People program.

* Excludes babies who were discharged from the Neonatal Intensive Care Unit, and other specific conditions. We use the exclusions developed by The Joint Commission, a national organization whose mission is "to continuously improve health care for the public, in collaboration with other stakeholders, by evaluation health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value."

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. The women were asked to rank the hospital on a 10-point scale, with 10 being "best hospital possible."

The chart below shows the percentage of women who rated the care they received during labor and delivery as 9 or 10. The data are provided on a month-by-month basis throughout 2009.

The chart below shows patient rankings of Cedars-Sinai Medical Center for obstetrical care compared to patient rankings nationwide.