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Upcoming
important dates, next steps for the SIVB Initiative...
(The Support for Birth initiative's weekly email newsletter comes out every Tuesday. As a reminder, it is your job as key contact to share relevant information with other team members at your hospital.)
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| Active? | | |  · Are nulliparous patients having c-sections for failure-to-progress before they are in active labor? This week Dr. Chescheir reviews a paper from the December 2010 Obstetrics & Gynecology suggesting that active labor begins later than we traditionally have believed, especially in nulliparous women. To read this overview, click here.
Of note, this study reports that spontaneously laboring patients were admitted at an average of 4cm (this includes nulliparous and multiparous patients). In the Support for Birth baseline data, the mean cervical dilation at admission among patients in labor was 3.75cm.
· Is your team actively engaged in working on the action plan you've created for this project? If not, let us know so we can help you move from the planning phase to the active phase.
· Do your data entry team members have active accounts on the Support for Birth data website? Are they actively entering data? Don't wait until the end of the month to work through a data backlog; keep your data as current as possible in the database. The sooner your complete data is in for the month, the sooner we can provide your team with a report.
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| What are we learning from the baseline data? | | | Each week, we'll look at an element of the data and report it to you here. For now, this will be based on the baseline data, but going forward we can begin to look for trends as the Support for Birth hospitals test changes to practice that we hope will lead to improvements in the vaginal birth rate.
Today's chart focuses on the use of cervical ripening among patients admitted for induction. The baseline data shows that among patients who admitted with a closed cervix (0cm dilation), not ruptured, and not in labor at admission, cervical ripening had a substantial effect on vaginal birth rates. Of patients admitted with a closed cervix who did not receive cervical ripening, only 30.8% had a vaginal birth, while 48% of patients who had cervical ripening gave birth vaginally, an overall relative risk of cesarean equaling 0.75 when ripened compared to not. As we increase our number of data points, we hope to learn which methods of cervical ripening have the best outcomes. Preliminary trends suggest that Foley bulb in combination with either Cytotec or Cervidil is associated with a higher rate of vaginal delivery than any of those methods alone, but the numbers are too small to draw any definitive conclusions. As SIVB teams enter more data, we will continue to monitor this trend.
It is also worth noting the low rate of vaginal birth among patients admitted for induction with a closed cervix, with or without cervical ripening, suggesting that inductions among these patients should be limited only to those situations where the medical indication for the induction is clear and supported by evidence.
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| "Reframing Birth and Breastfeeding: Moving Forward" - conference in Chapel Hill, March 11-12, 2011 | | |  The Coalition for Improving Maternity Services, in partnership with the Carolina Global Breastfeeding Institute and UNC Greensboro's Center for Women's Health and Wellness, is holding its annual meeting in Chapel Hill this year. For more information, go to http://www.motherfriendly.org/. This conference will include CE for nurses, lactation consultants and others. The session includes a pre-conference workshop on Mother-Friendly Labor Support on March 10.
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Contact Kate
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Kate Berrien, RN, BSN, MS
UNC Center for Maternal & Infant Health
CB# 7181
Chapel Hill, NC 27599
kberrien@unch.unc.edu
Phone: 919-843-9336 Fax: 919-843-7866 |
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