EBB 403 - Why Is My Hospital's Cesarean Rate So High (or Low)? with Dr. Emily White VanGompel, Family Medicine Physician and Research Scientist
Evidence Based Birth®Show Notes
Even when caring for similar patient populations, some hospitals have significantly higher Cesarean rates than others, and factors like teamwork, psychological safety, leadership, staffing, and beliefs about childbirth can affect outcomes. In this episode, Dr. Rebecca Dekker talks with family physician and researcher Dr. Emily White VanGompel about how the culture of labor and delivery units can shape decision-making and influence the birth experience for families.
Dr. White VanGompel explains the NTSV (nulliparous, term, singleton, vertex) Cesarean rate, why it is used as a quality measure, how hospitals have successfully reduced unnecessary Cesareans, and what families can look for when choosing a birth setting that supports vaginal birth. Plus, learn about the Labor Culture Survey (LCS), Dr. White VanGompel's research on the impact of the ARRIVE Trial on provider attitudes, and why conversations about reducing Cesarean overuse are important from a public health perspective.
(01:58) Growing up around home birth and discovering differences in birth culture during medical training (09:05) How family medicine influences perspectives on childbirth, postpartum care, and long-term family health (12:46) What NTSV Cesarean rates are and why they are used as a quality measure (16:19) Defining labor and delivery unit culture and how it affects Cesarean decision-making (19:23) Lessons from hospitals that successfully reduced Cesarean rates (23:50) Real-world examples of hospitals that transformed their birth culture and lowered Cesarean rates (29:36) Common attitudes and beliefs associated with higher Cesarean rates (32:32) The Labor Culture Survey (35:44) The ARRIVE Trial, provider attitudes toward induction, and shifting birth culture (43:01) How families can evaluate hospitals and providers when seeking support for vaginal birth (48:24) Midwifery models of care and their potential role in supporting vaginal birth (52:40) How personal birth experiences influence clinician attitudes toward Cesarean and vaginal birth
Resources View the original validation study that explains the creation of the LCS: https://onlinelibrary.wiley.com/doi/abs/10.1111/birt.12406 See how the first statewide use of the LCS found an association between labor culture and hospital-level cesarean rates: https://onlinelibrary.wiley.com/doi/full/10.1111/1475-6773.13123 Deep-dive into this qualitative study about how hospitals that lowered their cesarean rates changed their cultures: SpringerAccess research journals, articles, books and more | Springer Nature Linkarticle/10.1186/s12913-024-12108-3 See how this study used the Labor Culture Survey (LCS) to compare clinician beliefs and attitudes about induction of labor before and after the publication of the ARRIVE Trial: Sciencedirectsciencedirect.com science/article/abs/pii/S0884217522003914
For more information about Evidence Based Birth and a crash course on evidence based care, visit www.ebbirth.com. Follow us on Instagram and YouTube! Ready to learn more? Grab an EBB Podcast Listening Guide or read Dr. Dekker's book, "Babies Are Not Pizzas: They're Born, Not Delivered!" If you want to get involved at EBB, join our Professional membership (scholarship options available) and get on the wait list for our EBB Instructor program. Find an EBB Instructor here, and click here to learn more about the EBB Childbirth Class.
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