C-Section Delivery, Hemorrhage Risk Among Healthy Women Influenced By Hospital Management Practices: Study

Certain hospital management practices may substantially influence a pregnant woman’s risk of undergoing an unnecessary cesarean section, requiring a lengthy hospital stay, or experiencing excessive bleeding during delivery, according to the findings of new research. 

The way hospital managers run a unit, staff their nurses and manage patient flow all can place a woman at increased risk of needing a cesarean section, as well as increase the risks of hemorrhage, and the need of blood transfusions, according to a study published online July 11 in the journal Obstetrics & Gynecology.

Researchers from the Harvard T.H. Chan School of Public Health studied factors at 53 hospitals across the U.S. They conducted telephone interviews with 118 primary nurse and physician managers and scored the interview on management practices. They also conducted site visits at 11 hospitals. The study focused on whether the unit was reactive, addressed problems as they occurred, or proactive, attempting to mitigate problems before they arose.

Overall, they focused on three themes of management competencies. Those included management of the unit culture, including communication and collaboration among staff; patient flow, including adjusting the resources to accommodate surges in patient arrival; and nursing.

The study concluded proactive management of unit culture and nursing factors were associated with an increased risk of c-section in patients who were deemed low-risk for a c-section. Proactive management of patient flow and nursing factors was associated with a significantly lower risk of prolonged hospital stay.

Study authors said this is important because the numbers of c-sections have significantly increased in recent years. In one generation, the number of c-sections has increased 500 percent.

C-sections put women at increased risk of suffering surgical complications, hemorrhage, infections, longer hospital stays, higher costs and even death. Research has indicated nearly half of all c-sections are unnecessary and avoidable.

Likewise, proactive management of unit culture was also associated with a significantly higher risk of postpartum hemorrhage, blood transfusion, and prolonged hospital stay. The way a unit addresses the uncertainty of a woman getting a c-section is an independent risk factor itself.

Researchers speculate this may be because healthcare professionals may be less focused on maternal outcomes; instead, they may be highlighting neonatal outcomes, or perhaps financial performance.