Cesarean Births Reduced at One Hospital, with CMQCC support

Orange County, CA

NEWPORT BEACH, Calif.—Hoag Memorial Hospital Presbyterian, one of the largest and most respected facilities in Orange County, needed to move quickly.

A big insurer had warned that its maternity costs were too high and it might be cut from the plan’s network. The reason? Too many Cesarean sections.

“We were under intense scrutiny,” said Allyson Brooks, the executive medical director of Hoag’s women’s-health institute.

The hospital’s C-section rate at the time, in early 2012, was about 38 percent. That was higher than the state average of 33 percent and above the rates of most other hospitals in the area, according to the California Maternal Quality Care Collaborative, which seeks to use data to improve birth outcomes.

Within three years, Hoag had lowered its Cesarean-section rates for all women to just over a third of all births. For low-risk births (first-time moms with single, normal pregnancies), the rate dropped to about a quarter of births. Hoag also increased the percentage of vaginal births among women who had previously had C-sections; at 11 percent, it’s now roughly on par with the state average.