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Upcoming important dates, next steps for the SIVB Phase II Initiative...

(The Support for Birth initiative's weekly email newsletter comes out every Tuesday.)

 
October 30, 2012
Data Needed

question marksWe would like for each of you to complete a survey to help us better assess what types of services, protocols, and practices your hospital currently has in place. This will help us to focus our Phase III efforts over the next several months and move the initiative forward.

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In the literature...

news

To Posh to Push?

  

Unequal Motherhood: Racial-Ethnic and Socioeconomic Disparities in Cesarean Sections in the United States

Louise Marie Roth and Megan M. Henley

Social Problems, Vol. 59, No. 2 (May 2012), pp. 207-227 


Disparities in cesarean rates in the United States represent an important social problem because cesareans are related to maternal deaths and to the high cost of American health care. There are pervasive racial-ethnic and socio- economic disparities in maternity care as in health care more generally, yet there has been little scrutiny of how over- use of cesarean deliveries might be linked to these disparities. .....This research uses data on all recorded births in the United States in 2006 to analyze differences in the odds of a cesarean delivery by race-ethnicity and SES. The analysis reveals that non-Hispanic black, Hispanic/Latina, and Native American mothers are more likely to have cesarean deliveries than non-Hispanic white or Asian mothers. Also, after accounting for medical indications, increasing education is associated with a decline in odds of a cesarean delivery, especially for non- Hispanic whites. The results suggest that high cesarean rates are an indicator of low-quality maternity care, and that women with racial and socioeconomic advantages use them to avoid medically unnecessary cesarean deliveries rather than to request them.

Academy of Breastfeeding Medicine Founders Lecture 2009: Maternity Care Re-Evaluated. 
Marshall Klaus1 and Phyllis Klaus2  
BREASTFEEDING MEDICINE Volume 5, Number 1, 2010. 

 

Abstract:  In the 1990s a rising tide of medical, surgical, and instrumental interventions served to make childbirth almost treated like a disease. This report supports a different approach to childbirth. A case and discussions of induction are presented.

Conclusions:  To correct these high cesarean rates in the United States, we highly recommend the following:

  • Use the British example to allow labor to start on its own.
  • Avoid any unnecessary interventions such as inductions and epidurals.
  • Every mother should have a doula to reduce all the complications of labor.
  • Because of all the problems with epidurals, we recom- mend that their usage be significantly reduced.
  • Mothers should use a variety of known pain-relieving nonmedical methods, including hypnosis training, massage, warm baths, etc.
  • Allow the natural hormones, especially the three pain- reducing hormones, oxytocin, beta-endorphin, and me- socorticolimbic dopamine, to do their job and get the mother through labor with greater satisfaction. 
 


 

Culture:  Crossing the Threshold, Choosing a Path

patients voice

 

Organizations that make a decision to embark on cultural transformation journeys stand on the threshold and choose a path into the unknown. 

 

The process used or created to move forward on the path has a number of steps:

 

Assessing current reality, defining a desired state, guiding change, engaging the workforce, leadership commitment and support, involvement and ownership at all levels.

 

Guiding Change:  Organizations often identify or create a specific group to monitor and guide the change process i.e. steering committees, councils; transforming teams etc. these groups can be time-limited or permanent.  In successful cases groups include champions, frontline staff, patients, families and physicians.  The formal space created by the network of relationships serves as a  "holding environment" where members of the group address conflict, resistance or other difficult issues.

 

Engaging the Workforce:  Although the processes used to assess the current reality, define a desired state and guide the change process are necessary, the critical step in engaging the workforce is in creating an environment where new ideas and behaviors are welcomed and change experimentation and change are safe.

 

Do you promote an environment that is safe and welcoming to new behaviors and ideas?

 

To be continued next week.

 

(Kimball, 2005)

 

 

QI Tips

PDSA

 

Learning often comes from understanding the themes and patterns in the data. Themes can be gathered from documented observations such as complaints from customers.  Patterns in data also arise in using the different types of data shown. When dealing with continuous measurements or counts of observations, patterns are often easier to recognize when the data are plotted over time, as in a run chart.

Plotting data over time maximizes the learning from data. It allows the information to unfold as it happens and eventually display a pattern. The pattern may show improvement if you are testing a change or an opportunity for improvement. 

 

 

Langley, Gerald J.; Moen, Ronald D.; Nolan, Kevin M.; Nolan, Thomas W.; Norman, Clifford L.; Provost, Lloyd P. (2009-06-03). The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (JOSSEY-BASS BUSINESS & MANAGEMENT SERIES) (Kindle Locations 881-883). Wiley Publishing. Kindle Edition.

 

 

SIVB Cesarean Review

to do list

As discussed on the webinar, We are asking that each facility complete the SIVB Cesarean Review form on 10% of <41 weeks, unscheduled C-sections for the next month.  Each team should review the tool together and make the decision if the C-section was potentially avoidable or if it was unavoidable.  During the month the teams will make changes to the review tool to better help them to focus improvement efforts.  At the next webinar Forsyth will discuss what it has learned based on the tool.  Please let me know if your facility would be willing to share their experience with the use of the tool. The review tool can be found on the extranet - click here.


 

SIVB November Webinar

conference call The next webinar is Tuesday, November 27th, 7:30 - 8:30 AM.  Please plan to have at least one person from your team on the call so we can hear your 'voice'.     

Click here for webinar information.

 

Contact


Tammy Haithcox  

 

Tammy Haithcox

 

PQCNC Clinical Initiative Manager

 

[email protected]

 

 

 

 

 

 

 



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