The Patient and Family Advisory Council at Cambridge Health Alliance played a key role in an initiative to improve the experience of patients undergoing unplanned C-sections.  

Beginning in 2021, Cambridge Health Alliance formed a Patient Experience of Care Committee for its McGovern Maternity Suite and began to listen more formally to patient concerns about unplanned C-sections. 

Rachel Vogel, M.D., a family medicine physician practicing obstetrics at CHA, says that patients who expect and hope for a vaginal delivery but instead end up with major abdominal surgery are often dissatisfied. She notes that CHA is committed to keeping C-section rates low, but “we're still going to have patients with unplanned C-sections. How can we help them have the best experience possible?” 

Project seeks patient feedback on unplanned C-sections 

Dr. Vogel had worked with medical student volunteers to interview patients by phone for an earlier project, and she knew a member of CHA’s Patient and Family Advisory Council was interested. Dr. Vogel and Aideen Snell, M.S.W., Director of Patient Experience at CHA and co-chair of the hospital’s PFAC, developed a strategy in which the PFAC member would engage patients who had recently undergone unplanned C-sections in discussions about their experiences, structured to produce patient-centered action items. They also developed an online survey, which was offered to a separate cohort of patients ​in English, Portuguese, Haitian Creole, and Spanish.​ 

“The PFAC ensured the work stayed grounded in what matters most to patients, especially during these high-stress, vulnerable moments,” says Snell. “PFAC members pushed us to think more intentionally about equity—particularly regarding language and access.” 

The team drafted a series of questions to guide the interviews. Snell worked with the PFAC member, who was interested in maternal health disparities, to prepare for and conduct the interviews using a patient-centered, conversational approach that fostered trust and meaningful feedback. Interpreter Services was integral to the project, ensuring that non-English-speaking patients could fully participate. Interviews were scheduled with both the PFAC member and a qualified interpreter in the patient’s preferred language. 
 

​​Snell, who sat in on a few early interviews, was especially impressed by the PFAC member’s understanding of patient-centered care. “She was able to frame the questions according to the patient's comfort level as she went through the conversations,” says Snell. 

​The PFAC member documented the interviews and provided ​​detailed​​ ​​summaries​​​​ ​​​that enabled action from the ​clinical​ t​eam​​. ​The project evolved through close collaboration between clinical leadership and the PFAC, with patient advisors helping to shape both the approach and the resulting improvements.​​ 

Feedback was solicited from 63 patients with delivery dates between January 7 and May 31, 2024: 31 through phone interviews and 32 via an online written survey. ​​Of those, 19 patients completed the process (15 interviews and 4 surveys), providing rich qualitative insights that informed the project’s action items.​​ 

Action items were created based on patient input 

Nearly half of the patients interviewed or surveyed did not recall discussing the possibility of a C-section during prenatal education. CHA’s patient population is demographically and linguistically diverse, and this project found that non-English speakers were more likely to report not having had C-section discussions before delivery. 

Dr. Vogel says all patients at CHA receive written materials that describe C-sections as a possibility, and most providers discuss C-sections during prenatal visits. She notes, however, that part of the process needed more attention.  

As reported in CHA’s PFAC Annual Report for 2025, in addition to improving prenatal education, results from the interviews and surveys prompted CHA to:  

• add prompts to the pre-op huddle checklist to confirm patient preferences and the reason for C-section, 
• discuss standardized anesthesia counseling,  
• encourage providers to ask patients about their birth experience during postpartum daily rounding, and 
• standardize more consistent opportunities for skin-to-skin contact with the baby right after birth, even while still lying on the operating table. 

The project’s progress was monitored and discussed at PFAC meetings and was presented at CHA’s annual PFAC celebration, providing visibility to senior leadership. 

​​Snell says the PFAC’s contributions went far beyond an advisory role. “They influenced how we approached the work, how we defined meaningful change, and how we hold ourselves accountable,” she says. “This is what it looks like to integrate the patient voice into improvement—not as a symbolic step—they partnered with clinical teams to co-design improvements.​​”