Reduction of Cesarean Delivery in the “NTSV”

Population by Promoting Vaginal Birth

Pamella Weatherspoon, RN, Anna Marzano, RN, Macaria Solache, RN, Abbe Kordik, MD

Problem
• Cesarean sections are the most commonly performed surgery in the United
Results
• Since the initiative’s launch in December 2020, we have established interdisciplinary team buy-in toward a culture that promotes vaginal birth to reduce our
States. Cesareans, while necessary at times, can pose risks to patient and
newborn. The CDC reported Cesarean rates to be 31.7% of all births and NTSV Cesarean rate and have made progress on or completed each Structure Measure set by the ILPQC.
25.6% of low risk births in 2019. • As our rates have historically been mostly below the 24.7% goal, we took a deeper dive into our data by separating the groups into Spontaneous Labor vs.
• Healthy People 2020 set a goal to decrease Cesareans in the low-risk Induction of Labor. We noticed a disparity in C-section rates between the two groups and have been working with staff to focus on strategies to improve
population of nulliparous, term, singleton, vertex (NTSV) patients to outcomes for the induction population.
≤24.7%. • We review our data monthly by race and insurance status for equitable care and are partnering with the Birth Equity work group to make improvements on
• UCM routinely aimed for C-section reduction and rates were frequently this front.
≤24.7%; however, the Family Birth Center lacked structured educational • From tracking reasons for C-section delivery monthly, we have identified fetal heart tracing concerns as our primary cause for NTSV C-section delivery, in
systems and tools to achieve these measures. alignment with nationwide data for Cesarean indication.
• In alliance with the ILPQC Promoting Vaginal Birth (PVB) Initiative, we aim
to facilitate a culture that supports vaginal birth, by developing
standardized labor management processes with a focus on identifying labor
challenges and abnormalities that deter vaginal birth.
• Our QI Team is a collaboration of nursing, obstetric, and midwife providers
within the UChicago Family Birth Center.

Project Implementation
• Once our PVB team was formed, we began by reviewing baseline data and
developing a 30-60-90 day plan to organize our work.
• We developed mandatory labor management curriculum for nursing
personnel, aligning with resident education. This included a partnership
with neonatology to understand effects of vaginal birth versus Cesarean
delivery related to the newborn population.
• We standardized induction of labor scheduling to reduce non-medical
inductions and launched Intermittent Auscultation fetal monitoring for low
risk patients.
• We furthered education on ACOG/SMFM guidelines for Cesarean section
and worked with the Epic team to standardize documentation of these
guidelines being used in decision-making processes.
• Monthly, we review data and evaluate indications for Cesarean delivery in
relation to ACOG/SMFM guidelines and birth equity criteria.
• We formatted Cesarean decision and Pitocin/labor management huddles,
focusing on patient and family inclusion in decision making. These have not
been implemented formally yet as we are waiting on Epic documentation to
go-live.
• We celebrate rate reduction efforts with staff via a shout-out board and
daily huddles.
• We have seen great buy-in from staff and many nurses are using their off
Next Steps Acknowledgements/Hospital Team
time to advance their knowledge with the Spinning Babies™ course, peanut • Further resources distribution including patient handouts for managing early labor at home, Epic dot • We’d like to highlight the work of Initiative leads Dr. Abbe Kordik and
ball classes, and labor management workshops. phrases for documentation of huddles and decision making, and guides for peanut ball usage and Macaria Solache; Ola Tepede and April Caruso for Intermittent
• We are measuring success by achieving and maintaining an NTSV rate of patient positioning in labor are in the works. Auscultation policy development; Stacey Borrelli and the Epic Team for
≤24.7% and continued implementation and progression of ILPQC Structure • Nursing staff will shadow residents to understand provider use of ACOG/SMFM guidelines for each initiative enhancements; and Data and Analytics for data dashboard
Measures. patient to balance risks versus benefits of vaginal delivery or Cesarean. creation and upkeep. We’d also like to thank Spinning Babies™ and
• As part of our equity efforts, we will begin investigating Cesarean rates by BMI and comorbidities. Lamaze, Inc. for providing so many wonderful resources.