PSI 17: Birth Trauma Rate

Injury to the Neonatal

BY LEAH DAHLSTROM AND MCKENNA
MILING
Problem

• Birth trauma injuries include:

• Vacuum or forceps delivery
• Large-for-gestational age
• Malpresenation at delivery

• Complications from these interventions

are:
• Need for mechanical ventilation
• Sepsis
• Meconium aspiration
• Seizures
Literature Review

• Clarke et al. (2020) and her team,

conducted a study regarding
gestational diabetes mellitus in
Australia and was used to
compare pregnancy outcomes of
high-risk women that were
diagnosed with gestational
diabetes
Literature Review

• Krispin et al. (2017) conducted a

study on the perinatal outcomes
of cup detachment occurring
during vacuum-assisted vaginal
deliveries
Literature Review

• Cabacugan, E. & Gupta, R.

(2021) wanted to evaluate the
proportions, trends, resource
utilization, and risk factors of
neonatal trauma in the United
States
Assessment:
Stakeholders &
Partner Identification
• Patients & their families
• Physicians/obstetricians
• Nursing Staff
• Hospital
• Insurance Companies
• Regulatory Bodies
Assessment

Disparities

• Inadequate education
• Insufficient number of staff
• Lack of communication
• Lack of funding for continuing education

Cultural Factors

• Accepted practices regarding instrumentation usage

• Differences in training
 Guiding criteria from the American College of
Obstetricians and Gynecologists:

1. Cervix fully dilated

2. Rupture of membranes
3. Fetal head engaged (vertex presentation)
4. Knowledge of the fetal position
Current 5. Fetal weight has been estimated

Policies &
6. Maternal pelvis adequate for vaginal delivery
7. Anesthesia administered

Practices 8.
9.
The maternal bladder is empty
Maternal consent obtained, risk and benefits
thoroughly explained
10. A back-up plan if the operative delivery method
fails
11. Maternal cardiac or neurologic disease when
maternal pushing is not feasible
Laws in the United States

• No specific laws regarding the use of vacuums and forceps to assist with birth
• Various warnings about use of instrumentation has been published by the Food
and Drug Administration (FDA)
• 1998 public health advisory to health care professionals
• The Safe Medical Device Act of 1990 requires facilities to report deaths,
serious illnesses and injuries to the FDA, as well as to the device’s
manufacturer
• In 2017, Wrigley Obstetric Forceps recalled
• In 2020, Kiwi Complete Vacuum Delivery System recalled
Planning

Universal standard for obstetricians to use tools, such as There is not a lot of material resources needed, only a
forceps or a vacuum, and when they should not willingness to learn and accept change
Objective, Goals,
Outcomes

Objective: educating obstetricians and nurses on the proper

usage of obstetric instruments such as forceps and vacuums

Goal: educating obstetricians and nurses on proper use of

instruments, and providing earlier interventions,
assessments, and discussions for preventing fetal distress

Outcome: resulting in less neonatal birth traumas

SWOT

Strengths Weaknesses Opportunities Threats

• Collaboration • Complications • Decrease infant • No standardized
• Education increase mortality rates and education and care
• Reinforcing efforts • Noncompliance injuries across the board
that decrease the among obstetricians • The hospital could
incidence of and nurses because receive more
neonatal birth they are funding with
trauma uncomfortable with
change
Policy Development and Implementation
• New policies implemented beginning September 1, 2023
• Monthly outcomes evaluated January 2024 through January 2025
• Posters around the unit of when in-services would occur
• Hand-outs providing statistics on neonatal injury rates from the use of forceps and vacuums to
demonstrate the vitality of change
• Education would provided to staff as paid training
• Choose staff who are dedicated to the change to serve as project leads
 Resources for Policy Development
and Implementation
People from varying roles Other necessary resources
• Physicians • Large conference room
• Director of nursing • Computers
• Unit managers • Paper & pens
• Charge nurses • Education modules
• Staff nurses • Staff lunch
• Nursing assistants
Compliance Measurements

Team leaders of the project keep an audit of compliant doctors and nurses

Require monthly report for the first year of implemented training

Quarterly meetings with each staff

• Include audit provided by team leaders

Stakeholder feedback
• Seek feedback through a questionnaire form throughout first year
• Hold an annual review at the end of the first year

After 1 year of implementation, anonymous auditors will be hired to ensure policies

and standards are upheld
Policy Evaluation

• After a year of implementation, check in

periodically with staff to see how the delivery
of education is benefiting them and hold review
meetings if needed
• Measure staff compliance levels by monitoring
the rates of instrumentation usage and client
outcomes when instruments were used
• Annual meetings with director of nursing
• The team leaders will ultimately be the ones
who see it through, and they are the ones who
need to be especially passionate for having
these changes occur
Population Response & Sustainability
Implementation of change will incur cost

• Educational resources and associated supplies

Cost would be significantly less than expenses to due to neonatal birth injuries

• Life-long injuries :$4.3 million per person

• Productivity losses due to birth trauma & poor maternal outcomes: $6.6 billion annually
• Increased peripartum stays: $350 million yearly

Education is significantly more sustainable compared to the alternative of

neonatal birth injuries
 • Decrease incidence of:
• Scalp injuries
• Clavicular fractures
• Intracranial hemorrhage
Outcomes and • Brachial plexus injuries
Impact on • Need for mechanical ventilation
• Sepsis
Patient Safety • Meconium aspiration
• Seizures
• Reduce cost of care for patients and
their families
Conclusion

• By implementing continuous
education for health care
professionals directly involved in
providing neonate care, the
incidence of birth trauma rates
would decrease.
• Nurses have a duty to provide
safe and quality care for their
clients
References

Cabacungan, E. & Gupta, R. (2021). Neonatal birth trauma: Analysis of yearly trends, risk factors, and outcomes. The Journal of Pediatrics, 238. https://doi.org/10.1016/j.jpeds.2021.06.080

Clarke, E., Cade, T., & Brennecke, S. (2020). Early pregnancy screening for women at high-risk of GDM results in reduced neonatal morbidity and similar maternal outcomes to routine screening. Journal of Pregnancy.

https://doi.org/10.1155/2020/9083264

Evanson, S. M., & Riggs, J. (2022). Forceps Delivery. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK538220/

Greenwald July 14th, A. E. (2016, August 6). Vacuum extraction dangers and consequences- part 1. Joseph Greenwald & Laake, PA. https://www.jgllaw.com/blog/vacuum-extraction-

dangers-consequences-part-1#:~:text=In%201998%2C%20the%20Food%20and,fontanels%2C%20poor%20feeding%2C%20increased%20irritability

Krispin, E., Aviram, A., Salman, L., Chen, R., Wiznitzer, A., & Gabbay-Benziv, R. (2017). Cup detachment during vacuum-assisted vaginal delivery and birth outcome. Archives of Gynecology and Obstetrics, 296(5),

877–883. https://doi.org/10.1007/s00404-017-4507-5

O'Neil, S., Platt, I., Vohra, D., Pendl-Robinson, E., Dehus, E., Zephyrin, L., & Zivin, K. (2021, November 12). The high costs of maternal morbidity show why we need greater investment in maternal health.

Commonwealth Fund. https://www.commonwealthfund.org/publications/issue-briefs/2021/nov/high-costs-maternal-morbidity-need-investment- maternal-health

Shahat, A. R., & Greco, G. (2021). The economic costs of childhood disability: A literature review. International Journal of Environmental Research and Public Health, 18(7), 3531.

https://doi.org/10.3390/ijerph18073531
Questions?