In keeping with the dictum that the most important CD to prevent is the first one, the California Maternal Quality Care Collaborative (CMQCC) in 2016 introduced a large-scale quality improvement project designed to reduce nulliparous, term, singleton, vertex (NTSV) CDs across the state.
None of the 6 safety measures showed any difference when comparing 2017 (after implementation of the CMQCC bundle) to 2015 (before implementation), suggesting that patient safety was not compromised significantly.
The study population included intrapartum care clinicians (obstetricians, maternal-fetal medicine physicians, family physicians, midwives, and anesthesiologists, labor and delivery nurses, nurse educators, and nurse managers), recruited from 61 hospitals in California participating in the CMQCC Cesarean Collaborative, as well as 18 additional hospitals from a large northern California health system.
The sixth scale measures an individual's perceptions about their labor and delivery unit's norms and consists of eight questions created de novo from concepts identified in CMQCC's "Major Factors Influencing the Culture of Care and the Value of Vaginal Birth." (23) The survey underwent psychometric analysis, including exploratory factor analysis, iterative revisions using focus groups and individual interviews with labor and delivery personnel, and confirmatory factor analysis.