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Women and Pregnancy
The Department of Obstetrics and Gynecology at Cedars-Sinai is dedicated to quality of 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 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 , or
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
|Getting an Appointment at the Cedars-Sinai Prenatal Diagnosis Center||Jan - Mar 2008||Apr - Jun 2008||Jul - Sep 2008||Oct - Dec. 2008|
|Percentage of patients who rated the ease of getting an appointment excellent or very good.||97.6%||93.3%||94.6%||97.0%|
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.
|Caring for Pregnant Women Age 35 and older at the Cedars-Sinai Prenatal Diagnosis Center||2006||2007||2008|
|Number of referred patients who are 35 or older at the time of their pregnancy.||2,099||2,142||2,228|
|Number of noninvasive screens done during the first six months of pregnancy*||580||1,075||1,131|
|Number of women receiving chorionic villus samples (CVS)||1,718||2,023||3,092|
|The percentage of CVS samples for which a preliminary result is returned to the doctor in three days. (The goal is to have 95% of samples returned in three days.)||98%||91%||100%|
|Number of women receiving amniocentesis. (This is usually done between the 16th and the 22nd weeks of pregnancy.)||333||218||176|
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.
|Quality Measures for Delivery Care||Cedars-Sinai 2008||Nationally|
|Number of women having their first delivery by cesarean section among all women who are at risk of having their first delivery by cesarean section (primary cesarean rate).*||28.7%||23.5%*|
|Total number of women having a cesarean (either a primary or a repeat cesarean)||37.1%||31.8%*|
|Percentage of women who successfully deliver vaginally after having once had a cesarean (VBAC)||10.2%||8.5%*|
|Percentage of women who have an episiotomy during delivery.||5.7%||24.5%**|
|Percentage of women who have a severe vaginal or rectal laceration (tear). These are known as third or fourth degree lacerations.||2.5%||3.25%***|
|Percentage of women who deliver premature babies (after 24 to 34 weeks of pregnancy), who were given steroids before the birth to improve the outcomes for the infant.||97.0%||75.0%****|
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.
|Pain Management During Labor: Percentage of women who answered "definitely" to "amount of anesthesia and pain medication they received during labor and delivery was the right amount."||Cedars-Sinai||California Hospital Assessment and Reporting Taskforce Average|
|Jan - Mar 2008||81.3%||71.3%|
|Apr - Jun 2008||85.3%||71.3%|
|Jul - Sep 2008||79.6%||71.4%|
|Oct - Dec 2008||82.5%||71.3%|
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.
|In-Hospital Breastfeeding Rates*||Jan-Dec 2008||Jan-Mar 2009||Apr-Jun 2009||Jul-Sep 2009|
|Percentage of women who initiated breastfeeding during hospital stay||92.9%||92.7%||92.5%||94.8%|
|Percentage of women who were exclusively breastfeeding at discharge||63.3%||61.6%||60.2%||66.2%|
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 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 in the California Hospital Assessment and Reporting Taskforce.
|Labor and Delivery Patient Satisfaction Ratings||Cedars-Sinai Oct-Dec 2008||California Hospital Assessment and Reporting Taskforce Average|
|Percentage of women who rated the care they received as 8, 9 or 10 on a 10-point scale, with 10 being "best hospital possible"||84.3%||75.9%|
|Percentage of women who said they would recommend the hospital to their family members and friends||76.6%||60.6%|