Founded in 1921, Sutter Health is a not-for-profit integrated health delivery system that operates 23 acute care hospitals and over 200 clinics in Northern California, with engagement in 30,000 births each year. In 1999, Sutter Health established its first pregnancy and delivery quality improvement program to create better outcomes for mothers and babies. Reducing the number of unnecessary first birth C-section rates was a key goal. It is estimated that nationally, about 26% of healthy women with low-risk pregnancies still undergo C-sections despite the potential risks to mothers and babies. Over the next few years, Sutter Health concentrated on implementing its “community of improvement” approach across its entire system. The health system formed a community improvement committee and standardized processes to reduce variation and track progress. Sutter believes birthing is a natural process and not a medical intervention. They recommend admitting a mom only when in active labor to reduce intervention, which reduces the likelihood of a C-section. Once admitted, each patient receives continuous labor support from her Sutter birthing team. From the outset, Sutter Health focused on establishing a culture of teamwork and creating specific expectations for each position on a birthing team. The birth team consists of physicians, nurses, midwives and volunteer doulas, who are available free of charge to support any nonmedical needs of an expectant mother during labor and delivery. Water births also are an option. Each team member provides encouragement and support throughout labor and delivery.
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