Women of childbearing age need accurate, objective data in order to make informed choices about birth settings and providers. The Birth Survey, a mechanism to share, systematically track, and retrieve up-to-date information about the quality of care received will equip consumers with the information necessary to make informed decisions and enable individuals to play a larger role in determining their care and to make real informed health care choices.
As a Patient-Centered Maternity Home, two components of our Maternal-Child Health Care are evidence-based practice and shared decision-making. While ACOG guidelines are not always evidence-based, they have recently released guidelines allowing us all to offer trial of labor to women with two prior cesareans or twins. Our cesarean rate is 19% and our VBAC rate is 50%. North Carolina Medicaid is currently reimbursing cesarean birth at the same rate as vaginal birth.They were proactive in setting the rates pretty close to each other in years past.
The Safe Motherhood Quilt Project, originated by midwife Ina May Gaskin, is a national effort developed to draw public attention to the current maternal death rates, as well as to the gross underreporting of maternal deaths in the United States. The Quilt honors American mothers who have died of pregnancy or childbirth related causes since 1982, the last year there was a reduction in maternal mortality.
The goal of the Safe Motherhood Quilt Project is to demand an equivalent system of counting, analyzing, and learning from mistakes made in our maternity care system here, regardless of where babies are born or what caregiver is the birth attendant. Until we do that, doctors, midwives, and nurses in the US will continue to work without a good system of feedback about what is and is not dangerous in maternity care, and preventable maternal deaths will continue to take place.
In the Literature: San Francisco General Hospital implements skin-to-skin care in the operating room for mothers and infants after cesarean surgery
The improvement team altered the process of care in the operating room to enable routine, early skin-to-skin contact after cesarean birth, with the aim of increasing the success of breastfeeding initiation.
From the Field: Eliminating Preventable Perinatal Injuries and Reducing Malpractice Claims and Costs: Creating High Reliability Obstetrics Units
We intend to reduce perinatal harm and decrease malpractice events by eliciting improved compliance in 4 clinical care bundles and implementation of an evidence-based simulation training methodology focused on improving clinical staff’s ability to work in teams. We are measuring our impact through a culture of safety survey and a high reliability survey, various outcomes measures.
In the Literature: At Intermountain, process improvement reduces inductions, cesareans, NICU admissions, and costs
As a result of process improvement efforts bolstered by robust information systems, the proportion of all inductions that lacked strong indications for clinical appropriateness fell from 28 percent to less than 2 percent. The project also resulted in decreases in both NICU admissions and cesareans, and Intermountain estimates that the elective induction protocol reduces health care costs in Utah by $50 million per year.
NH Patient Voices’s mission is education and advocacy for safe, quality, compassionate healthcare that puts patients & their families at the center of care in both policy and practice. Since 2005, we’ve worked tirelessly to bring the collective voice of patients to healthcare providers, administrators, legislators, public policy, and public health leaders.
We wanted to design a center where the needs of the mother and the baby come first. A place where every aspect of care is based on supporting natural birth and breastfeeding.
In the Literature: Geisinger’s ProvenCare safely reduces cesarean rate with implementation of evidence-based guidelines
Geisinger Health Systems in Pennsylvania set out “to demonstrate that a large integrated health care delivery system, enabled by an electronic health record (EHR), could successfully reengineer a complicated clinical process, reduce unwarranted variation, and reliably deliver evidence-based care.” Geisinger has successfully demonstrated effectiveness in acute care specialties with their ProvenCare system and sought to adapt it to perinatal care, for the first time addressing a largely well population and integrating multiple outpatient clinics.
We set out to change the method that is used to measure the results of different labor management strategies. We created an indicator that uses each patient’s unique physical characteristics to adjust an obstetrical care provider’s cesarean delivery rate to reflect the physical characteristics of their patient population. This indicator is called the Birthrisk Cesarean Birth Measure.