Sutter Health's First Pregnancy and Delivery (FPAD) OB Quality program has focused on the L&D management of nulliparous women. Started in 1999, it has centered on reduction of: episiotomies (and hence 3rd/4th degree lacerations), elective induction of term labor and early admission (<3cm dilation) (and hence labor cesareans) (see Main, E et al, AJOG 1998; 196:225-32). Sutter Health has >40,000 total births per year. We have had great success in reduction of episiotomies (from 45% of first time births to the current 14%). Recently we identified that >65% of the inter-hospital variation in Cesarean Birth rate for low-risk nulliparous women was due to differences in the rates of induction and early pregnancy admissions. The keys to the successful quality improvement efforts were continual audit and feedback combined with professional education.
