Improvement Stories

Introduction

Maternity care providers and professionals share stories of improvement in a question and answer format that allows others to read about lessons learned, keys to success in promoting changes included in the Menu of Change. The authors share new approaches and recommendations to make changes to physiologic birth. 

• Reducing Primary Cesarean Births Initiative Success Story

  Contributors: Becky Gams, RN, MS, CNP and Carrie Neerland, MS, CNM

  Summary: As a part of the Reducing Primary Cesareans (RPC) Collaborative, the team at the University of Minnesota Medical Center & University of Minnesota Masonic Children’s Hospital and successfully decreased their primary cesarean rate by over 10% in one year.
  

  
  

• ACNM RPC Success Story - Winthrop Hospital NY

  Contributor: Melanie Sumersille, CNM

  Summary: The team at Winthrop Hospital utilized the Promoting Spontaneous Progress in Labor bundle as a part of the Reducing Primary Cesareans (RPC) Collaborative.
  

  
  

• Highland Hospital Implements Intermittent Auscultation to decrease the Primary Cesareans Rate as part of the RPC

  Contributor: Karen Meyer, CNM

  Summary: Highland Hospital joining the Reducing Primary Cesareans (RPC) Collaborative with a goal of implementing intermittent auscultation as appropriate to decrease their primary cesarean rate for low-risk women.
  

• RPC Improvements
  Contributor: Katie Page, CNM.  The team at Centra Medical Group Women’s Center has been working as a part of the Reducing Primary Cesarean Collaborative to evaluate outcomes including NTSV cesarean, via implementing bundles to promote physiologic labor and comfort & coping in labor.

  
  
• Second Stage Labor: Promoting Physiologic Pushing and Laboring Down

  Contributors: Mary Kindle BSN, RNC, CPHQ; Marshe Remynse MSN, RN, FNP-BC; Beth Sangalli BSN, RNC; Jennifer Burhans MSN, RN
  Bronson Methodist Hospital agreed to participate in the Michigan Hospital Association Keystone OB Collaborative. One of the indicators for this initiative was management of second stage of labor, which included laboring down and non-directed, open glottis pushing
  
  

• Increasing Acceptance, Comfort and Use of Placing Mother and Neonate Skin to Skin Immediately After Birth

  Contributor: Deborah McBain, CNM, MSN
  At Henry Ford Hospital a team of three, a nurse, a neonatal nurse practitioner and a nurse midwife changed practice to make skin to skin the standard of care after all vaginal births.
  

• Promoting Comfort in Labor: Aromatherapy as a Care Intervention

  Contributor: Katherine Todd, PN, DNP
  Aromatherapy was implemented at Park Nicollet's Methodist Hospital as a natural, supportive and evidence based intervention in order to increase their patient centered approach and decrease pharmaceutical interventions.

   

• Promoting Comfort in Labor: Nurses Implement Use of Acupressure

  Contributor: Sharon Dalrymple RN, BN, MEd, LCCE, FACCE
  The High River Hospital Community Maternity Program added accupressure to their wide range of comfort/support skills in caring for women in active labor.
  

• Fetal Health Surveillance: Switching to Intermittent Auscultation

  Contributor: Sharon Dalrymple RN, BN, MEd, LCCE, FACCE
  The High River Hospital Community Maternity Program adopted new Fetal Health Surveilllance (FHS) guidelines on Intermittent Auscultation (IA) in appropriate situations that matched their Low Risk program and philosophy.
  

• Delayed Cord Clamping for Selected Cesarean Sections- Emergent and Elective

  Contributor: Sharon Dalrymple RN, BN, MEd, LCCE, FACCE
  The High River Hospital Community Maternity Program adopted recommended delayed cord clamping practice for vaginal births, then extended the practice to C/S patients as well, when appropriate.
  

• Identification and Manual Rotation of the Occiput Posterior Fetus

  

  

  Contributors:
  Cathy L. Emeis, PhD, CNM
  Sally Hersh, DNP, CNM
  Manager, OHSU Nurse-Midwifery Practice
  Oregon Health and Science University (OHSU) introduces manual rotation of the occiput posterior fetus to improve vaginal birth rates and decrease complications related to persistent OP position.

  
  

• Prenatal Shared Decision-Making for Analgesia and Anesthesia in Labor

  Contributor: Tami Michele, DO, FACOOG
  Spectrum Health Gerber Memorial OB/GYN created a prenatal workflow to improve women’s knowledge of the possible beneficial and harmful effects of epidural anesthesia and explore alternative methods of pain relief

• Adaptation and Implementation of a Guideline for Second Stage Labor for Women with Epidural Analgesia

  Contributors:
  Samantha A. Sommerness, DNP, RN, CNM
  Melissa D. Avery PhD, CNM, FACNM, FAAN
  Becky L. Gams, RN, MS, CNP
  Dr. Sommerness shares her experience at Fairview Health System where they implemented use of laboring down to reduce the incidence of cesarean birth and instrumental delivery.

• Sharing Information about Active Management of Third Stage of Labor with Women

  Contributor: Joanne Motino Bailey, PhD, CNM,
  University of Michigan Midwifery Service Offers Women Information about Active Management of Third Stage Labor.
  

  
  

• Introducing Nitrous Oxide for Labor Pain Relief

  Contributor: Michelle Collins PhD, CNM
  Vanderbilt University Medical Center takes a team approach to introducing nitrous oxide for labor pain relief. 

  
  

• Increasing Use of Intermittent Auscultation for Low-Risk Laboring Women

  Contributor: Cathy Emeis, PhD, CNM
  Oregon Health Sciences University (OHSU) Midwives increase use of intermittent auscultation for low risk laboring women.