State of the Union

If you're new here, the first thing you need to know about me is that I LOVE data. When we have clear numbers, quality information, then we can start asking the good questions and making decisions. So when a fellow ICAN co-leader posted a link to the National Accreta Foundation's Data Report on the United State's Cesarean data, I was practically salivating.

Only practically, not actually. I promise, I am not a teething infant.

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Back to SCIENCE!

The National Accreta Foundation is a non-profit organization whose mission is eliminating preventable maternal mortality and severe maternal morbidity attributable to placenta accreta.

According to the American College of OB/GYNs, placenta accreta is when at least part of the placenta invades and is inseparable from the uterus. The risk of developing placenta accreta increases drastically with increasing number of previous Cesarean deliveries, so reducing the number of unnecessary Cesareans is of utmost importance to reduce the incidence of placenta accreta, a condition that carries significant risks to both mothers and babies.

Relevant to Nebraska, the National Accreta Foundation reports Nebraska's NTVS (Low-Risk) Cesarean rate and the VBAC rate for 2016, using data from the CDC.

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The NTVS Cesarean rate is an important data point for evaluating the local practices that may drive overall Cesarean rates. The NTVS stands for Nulliparous, Term, Vertex, Singleton. Nulliparous means a woman who has not given birth before, a first birth. Term means the baby is being born between 37 and 42 weeks of pregnancy, full-term. Vertex means the baby is in the head down position. Singleton means just one baby, not twins or other multiples. These pregnancies are also Low-Risk, meaning there is no medical condition present that would increase the risk of Cesarean delivery. These pregnancies have the highest chance of proceeding vaginally, so by looking at the Cesarean rates in this group of very low-risk women, babies, and pregnancies, we can learn quite a lot about what is driving Cesarean rates in a practice, hospital, city, state, region, country, and more. The Healthy People 2020 objective is to reduce the national NTVS rate to 23.9% by 2020. Nebraska's NTVS Cesarean rate for 2016 was 23.8%.

VBAC, or Vaginal Birth After Cesarean, "is associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies as well as a decrease in the overall cesarean delivery rate at the population level." By increasing access to VBAC, we can reduce the number of unnecessary Cesareans, including placenta accreta. The Healthy People 2020 objective for VBAC is a bit more difficult to interpret, it's worded in terms of repeat Cesareans. In 2007, 90.8% of women with low-risk pregnancies and a previous Cesarean birth had a repeat Cesarean. The 2020 goal is to decrease this rate of repeat Cesarean to 81.7% by 2020. In other words, the 2020 objective is to increase VBAC to 18.3%. Nebraska's VBAC rate for 2016 was 13.7%.

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Joyce Dykema