| Next all-team webinar is March 22 at 7:30 am |
| |
 Make sure all of your team members are aware of the next webinar. This month, we'll hear from Dr. Angela Gantt and L&D nurse manager Donna Lane from WakeMed about their approaches to induction of labor and its relationship to their c-section rate. We also will be asking teams that have higher and lower rates of IOL and spontaneous labor and those teams with higher and lower vaginal birth rates among their IOL patients to describe the forces that may be driving those rates. If your team has a specific best practice or challenge you would like to present during the webinar, please let me know.
|
| Induction of labor protocols, policies and standing orders |
| |
 During the February webinar, we agreed that we would collect the induction policies, protocols and standing orders that Support for Birth teams are currently using. If you have not done so already, please submit those to s4binitiative@gmail.com and we will post them on the Extranet.
|
| March journal article reviews from Dr. Chescheir |
| |
 Many participating hospitals have shared that one strategy for increasing the vaginal birth rate in the NTSV population is to dissuade patients and doctors from elective inductions prior to 41 weeks or to limit such inductions between 39 weeks and 41 weeks only to women with a favorable cervix. Two articles support these efforts with very convincing data from relatively large numbers of patients. The bottom line is that the NTSV patient undergoing induction of labor with an unfavorable cervix has a 2-2.7 fold increased risk of an unplanned cesarean section compared to someone in spontaneous labor or someone being induced with a favorable cervix. The data appears to be nearly the same for women having medically indicated and elective inductions. There is just something about an unripe cervix that decreases the chance of vaginal birth... Click here to read a summary of these two studies.
|
| Data notes for the week: |
| |
 Thank you to all of the teams who are working on getting February data entered. Jessica is reviewing the data from each team and following up by email to try to fill in any gaps. You can contact Jessica by email (jphipps@email.unc.edu) with data questions. We will generate monthly reports at the end of this week unless we hear from you that your data is incomplete. The website will be down today for several hours, so we will wait until March 11 to generate reports. A few data pointers this week:
· Time interval from PROM to active labor/Pitocin initiation: this question seems to be causing confusion. The question asks the length of time in hours from when the membranes ruptured to when the patient went into active labor OR when Pitocin was started, whichever came first. If a patient went into labor and was later augmented with Pitocin, you do not need to document that here; this question is trying to measure the length of time between PROM and when something happened that would represent the beginning of that patient's labor.
· NTSV inductions with c-section for malpresentation: occasionally a patient is admitted for induction of labor as an NTSV patient but subsequently has a c-section due to a previously unrecognized malpresentation. These patients should be included in the dataset; they were admitted and treated as an NTSV patient.
· Keep trying to provide as complete data as possible: labor support methods and the questions related to failure-to-progress c-sections (use of IUPC, cervical dilation at time of decision to proceed to c-section) are directly related to processes for which some teams are testing changes, so complete and accurate data will help know if those changes are leading to improvements.
Remember that the data is not the purpose of the project, it is a tool to let you know if you are making progress toward your goals. Is your team focusing its energy on testing the changes that may lead to improvements in the vaginal birth rate?
|
Contact Kate
|
|
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 |
