LDH Business PlanThis Mother’s Day, the Louisiana Department of Health is proud to announce the statewide cesarean delivery rate among the vast majority of Louisiana hospitals in 2021 fell to 28.5%, from 33%, in large part thanks to the work of Louisiana hospitals participating in the Department’s Safe Births Initiative. The Safe Births Initiative, led by the Louisiana Perinatal Quality Collaborative (LaPQC), is an ongoing effort to reduce Louisiana's maternal mortality and morbidity rates, which are among the worst in the nation.
In addition to the Safe Births Initiative, LDH is pleased to announce that 16 of the state’s 42 hospitals participating in The Gift, a breastfeeding program aimed at boosting Louisiana’s low breastfeeding rate, have qualified for a strengthened third iteration of the program, The Gift 3.0. All 42 hospitals are expected to achieve re-designation by 2023.
Reducing the state’s cesarean delivery rate and increasing the number of mothers breastfeeding – particularly among African-American mothers, whose initiation rate is disproportionately low – are among key goals in the LDH Business Plan. The plan outlines a commitment to improve outcomes from pregnancy through childhood, and emphasizes collaboration between health providers and across LDH programs.
“Motherhood is truly a gift, and I have directed the Department to use every resource available to make a difference where it counts – giving Louisiana moms the support they need to have happy, healthy babies and receive the highest quality care regardless of their background,” said LDH Secretary Courtney N. Phillips. “In pursuing these goals, we emphasized coordination across healthcare systems and programs to make sure we achieve goals that deliver tangible results for moms and their babies.”
Major progress made in improving birth outcomes
Before the launch of the Business Plan in 2021, it was clear that cesarean delivery rates, at 33%, were too high. While cesarean deliveries can be life-saving procedures, they should be the exception, not the rule.
An unnecessary first-time, low-risk cesarean birth is an indication of hospitals inconsistently applying best practices that are advanced under the LaPQC, which is part of the Department’s Bureau of Family Health (BFH) and an activity of the Louisiana Commission on Perinatal Care and Prevention of Infant Mortality. Since 2018, the LaPQC has been working with hospitals to adopt best practices around preventing negative outcomes due to severe hemorrhage and hypertension, with significant progress reported last year.
The Safe Births Initiative’s cesarean delivery rate accomplishments reported this Mother’s Day are continuations of the Reducing Maternal Morbidity and Mortality Initiative. In addition to the reduction of cesarean births, facilities reported over 90% compliance with quantitative blood loss measurement and hemorrhage risk assessment at admission, and over 70% compliance with timely treatment of severe hypertension in 2021.
Collaboration in boosting breastfeeding rates
Strengthening LDH programs that target enhanced breastfeeding practices and quality of care in Louisiana hospitals holds the potential to improve the lives of moms and their babies across Louisiana, and particularly among vulnerable populations that have faced historic barriers. Breastfeeding rates in particular are too low: 70% of Louisiana moms initiate breastfeeding compared to 84% nationally.
The Bureau of Family Health has been working to boost Louisiana's breastfeeding rates through the hospital-based breastfeeding program, The Gift, since 2006. In the revamp of The Gift 3.0, hospitals engage in collaborative learning with the LaPQC; ensuring staff competency in fundamentals of breastfeeding and infant nutrition; report monthly data, including stratification by race; routinely survey moms about their hospital-based education, and complete patient partnership and equity activities.
The Business Plan’s emphasis on collaboration between departments includes improving coordination between the Gift 3.0, which is hospital-based, and home-based resources available under the Women, Infant and Children’s Program.
WIC is working toward improving systems that support breast milk as first food to increase breastfeeding initiation among Medicaid beneficiaries in Louisiana, particularly around peer support.
WIC has exceeded its goal to ensure all regions have adequate WIC breastfeeding peer counselor coverage (defined as greater than 70% of all WIC clinics with a peer counselor assigned), providing 76% of all WIC clinics with a counselor, including coverage for many rural areas that did not previously offer the service.
In addition, WIC has revised and distributed materials to promote breastfeeding resources, such as breast pumps and peer counselor support, including materials available in Spanish; made a mobile app available to participants, called Pacify, that offers 24/7 breastfeeding counseling; and debuted virtual support groups to regions with low breastfeeding rates via Zoom meetings for WIC members.
Breastfeeding rates among WIC participants have increased from 33% in 2020 to 42% in November 2021. 
As Louisiana prepares to celebrate Mother’s Day, we are reminded that every woman has the right to a safe, equitable birth. Through its work in BFH and WIC, LDH is committed to improving outcomes from pregnancy through childhood.