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Reducing Primary Cesareans

What Are Bundles?

The concept of the bundle was developed by the Institute for Healthcare Improvement (IHI) as a way to support health care professionals to provide the best care possible based on available evidence. According to IHI “A bundle is a structured way of improving the processes of care and patient outcomes by using a small, straightforward set of evidence-based practices— generally three to five— that, when performed collectively and reliably, have been proven to improve patient outcomes”1. The process of improvement through the use of a bundle is that it ties the evidence based care practices together into a package of approaches to care or interventions that are “followed for every patient, every single time”2. Click to link to Toolbox Resources

With funding support from the Transforming Birth Fund ACNM has launched the Reducing Primary Cesarean Project. This project is focused on the development of hospital based perinatal collaboratives that implement one of three bundles which aim to reduce unnecessary cesareans. The three bundles, available in the bundles tool box, are the following:

  • Intermittent Auscultation

  • Promoting Spontaneous Labor Progress

  • Promoting Comfort in Labor

ACNM has also participated in the development of several bundles as a part of multi-disciplinary teams to improve safety and quality in maternity care. In particular, ACNM has joined the Core Partnership of the Alliance for Innovation on Maternal Health (AIM) Program. AIM isa national partnership of organizations working to reduce maternal mortality by empowering every state in the US to implement quality improvement and safety bundles that address the significant contributors to pregnancy-associated maternal morbidity and mortality. Available bundles for the AIM project are located at and include the following topics:

  • Obstetric Hemorrhage

  • Severe Hypertension in Pregnancy

  • Prevention of Venous Thromboembolism in Pregnancy

  • Support for Intended Vaginal Birth

  • Protocols and Resources to Support Patients, Families, and Staff

  • Postpartum Care Basics for Maternal Safety

  • Reduction of Peripartum Racial Disparities

  • Patient, Family, and Staff Support after a Severe Maternal Event



  1. Resar R, Pronovost P, Haraden C, Simmonds T, et al.Using a bundle approach to improve ventilator care processes and reduce ventilator-associated pneumonia. Joint Commission Journal on Quality and Patient Safety. 2005;31(5):243-248.

  2. Institute for Healthcare Improvement ( retrieved September 16, 2015).



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