GenIC #76 (New): Expressions of Interest in the Improving Maternal Health by Reducing Low-Risk Cesarean Delivery Affinity Group

Maternal and Infant Health Initiative
Improving Maternal Health by Reducing Low-Risk Cesarean Delivery
Affinity Group Fact Sheet
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce the Improving
Maternal Health by Reducing Low-Risk Cesarean Delivery Affinity Group. This affinity
group will support states in convening stakeholders and implementing quality improvement
projects that reduce the number of low-risk cesarean deliveries (LRCD) among Medicaid and
Children’s Health Insurance Program (CHIP) beneficiaries, and in driving improvement in
maternal and infant health. The affinity group will be preceded by a webinar series
demonstrating the role LRCD births plays in maternal and infant health and outlining strategies
state Medicaid and CHIP agencies can use to reduce the number of LRCD births. Additional
information on the webinar series can be found on the CMS LRCD landing page.
Why Focus on Reducing the Number of Low-Risk Cesarean Deliveries?

Cesarean deliveries are considered low risk when they are nulliparous (first birth), term (37 or
more completed weeks), singleton (one fetus), and cephalic (head first). For low-risk
pregnancies, cesarean delivery can pose a greater risk of maternal morbidity and mortality than
vaginal delivery. 1 Early complications from cesarean delivery for the birthing person may
include infection, hemorrhage, and uterine rupture.2 Later complications may include abdominal
wall endometriosis and cesarean scar defect. 2 Infants born through cesarean delivery are more
likely to have breathing and respiratory issues and surgical injury from the procedure, making
them subject to complications as well. 3 Because of the known risks of cesarean delivery for lowrisk pregnancies, the U.S. Department of Health and Human Services set a Healthy People 2030
goal of 23.6 percent for the LRCD rate. 4 In 2020, the LRCD rate for all birthing persons was
25.9 percent, with notable disparities between Black and White birthing persons (30.6 percent
and 24.7 percent, respectively). 5 Because Medicaid covers 42.0 percent of all births in the
United States, reducing the number of LRCD births is an opportunity for state Medicaid and
CHIP programs to improve the quality of maternal and infant health and reduce overall maternal
morbidity and mortality.
The Opportunity

To reduce the rate of LRCDs for Medicaid and CHIP beneficiaries, CMS is pleased to launch the
Improving Maternal Health by Reducing Low-Risk Cesarean Delivery Affinity Group. The
affinity group will provide technical assistance to state Medicaid and CHIP agencies and their
partners through group workshops and one-on-one meetings with state teams. Quality
improvement (QI) advisors and subject matter experts will provide state teams with
individualized guidance, including QI tools to identify, implement, and test change ideas to
reduce LRCDs and scale changes that prove successful. Participating states will meet monthly
from July 2022 to June 2024 to develop and test data-driven interventions. States will work with
CMS to improve their performance on the Low-Risk Cesarean Delivery (LRCD-CH) Child Core
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Set measure 6, which is also included on the Maternity Core Set 7, and to identify other relevant
indicators to track quality improvement.
State Medicaid and CHIP Team Learning Objectives

The affinity group’s state Medicaid and CHIP QI teams will:
•

Meet monthly for virtual workshops and one-on-one state coaching calls, learning from QI
advisors, subject matter experts, and peers

•

Improve QI skills through workshops and individual state QI team coaching

•

Identify data sources and produce analytics in collaboration with partners to develop QI
strategies and track their effectiveness

•

Work with partners to test, implement, and assess QI ideas for changes

Application and Selection
To participate in the affinity group, please complete and submit the Expression of Interest (EOI)

form by May 31, 2022, 8:00 PM ET. In addition to the relevant state Medicaid and CHIP staff,
states are strongly encouraged to include representatives from hospitals, state hospital
associations, state perinatal quality collaboratives (where available), obstetric providers, and
state obstetric associations. States are also encouraged to work with their Medicaid and CHIP
managed care plans, health departments, their State Title V MCH Programs, and other relevant
state partners as part of their QI work. Once they receive the EOI form, CMS and the QI
technical assistance team will contact the proposed state QI team leader to discuss the state’s
participation and improvement goals.
Criteria used in selecting participants for the affinity group include:
•

Medicaid or CHIP staff leaders or co-leaders who are willing and available to work about 10
hours each month on the QI project

•

Well-articulated goals for reducing LRCD rates

•

An understanding of the challenges and opportunities faced by state Medicaid and CHIP in
working to reduce rate of LRCD

•

Access to data on low-risk cesarean delivery through partners and/or vital records, and access
to other data as needed for QI

•

Identification of a well-rounded state planning team and an ability to convene and engage
partners to drive improvement

•

Demonstrated support from Medicaid or CHIP executive leadership

Questions?

Please submit your questions to the technical assistance mailbox at
[email protected].
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Sandall, J., Tribe, R.M., Avery, L., Mola, G., Visser, G.H.A., Homer, C.S.E., Gibbons, D., Kelly, N.M., Kennedy, H.P.,
Kidanto, H., Taylor, P., & Temmerman, M. (2018). Short-term and long-term effects of cesarean section on the health of women
and children. The Lancet, (392)1, 1349–1357.
https://www.sciencedirect.com/science/article/pii/S0140673618319305?via%3Dihub
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2 Rosa, F., Perugin, G., Schettini, D., Romano, N., Romeo, S., Podesta, R., Guastavino, A., Casaleggio, A., and Gandolfo, N.
(2019). Imaging findings of cesarean delivery complications: cesarean scar disease and much more. Insights in Imaging, (10)1,
98. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6757074/

American Pregnancy Association. C-section complications. https://americanpregnancy.org/healthy-pregnancy/labor-and-birth/csection-complications/
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4 U.S. Department of Health and Human Services. (n.d). Reduce cesarean births among low-risk women with no prior births –
MICH-06. Healthy People 2030. U.S. Department of Health and Human Services, Office of Disease Prevention and Health
Promotion. https://health.gov/healthypeople/objectives-and-data/browse-objectives/pregnancy-and-childbirth/reduce-cesareanbirths-among-low-risk-women-no-prior-births-mich-06

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Osterman MJK, Hamilton BE, Martin JA, Driscoll AK, Valenzuela CP. Births: Final data for 2020. National Vital Statistics
Reports; vol 70 no 17. Hyattsville, MD: National Center for Health Statistics. 2022.
https://www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-17.pdf

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2021 Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP (Child Core Set).
https://www.medicaid.gov/medicaid/quality-of-care/downloads/2021-child-core-set.pdf
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2021 Core Set of Maternal and Perinatal Health Measures for Medicaid and CHIP (Maternity Core Set).
https://www.medicaid.gov/medicaid/quality-of-care/downloads/2021-maternity-core-set.pdf

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