Recommended Citation
Davis-Larkin T, Kocur K, Swiatkowski V, et al. Promoting vaginal birth in the nulliparous term singleton vertex (NTSV) patient. Quality Improvement poster presentation at Empowering Nursing Excellence: Recognizing the Value and Impact of Nurses, Advocate Health Midwest Region Nursing Research & Professional Development Conference 2023; November 15, 2023; virtual.
Presentation Notes
Quality Improvement poster presentation at Empowering Nursing Excellence: Recognizing the Value and Impact of Nurses, Advocate Health Midwest Region Nursing Research & Professional Development Conference 2023; November 15, 2023; virtual.
Abstract
Background
Cesarean section (C-section) delivery can be a lifesaving procedure but is overused and can also be dangerous. Improvements focused on ‘first births’ (nulliparous, term, singleton, vertex (NTSV) deliveries) help prevent repeat C-sections.
Local Problem
The C-section rate for NTSV births in the Labor and Delivery (L&D) unit at a large, urban, Level 1 trauma center was 31.9% in January 2022, indicating C-section overuse and initiating a a unit goal to reduce the rate.
Method
We shared current C-section rates, required computer-based training modules about C-sections and vaginal births, discussed vaginal versus C-section criteria for each patient during morning huddles, rolled-out a pre-C-section checklist with C-section prevention algorithms used during labor, and educated nurses about alternative methods to prevent C-sections. Alternative methods included early labor ambulation using wireless monitors, ‘spinning babies’ classes, and a ‘promoting vaginal birth (PBV)’ newsletter featuring success stories and a ‘position of the month.’ Nurses with successful NTSV deliveries were recognized with a stork charm for their uniform and using online recognitions.
Results
From January 2022 year to March 2023, the unit reduced C-section rates for NTSV patients from 31.9% to 27.2%
Implications for Practice
This project employed many different methods at one time, so evaluating the effectiveness of each is a challenge. Anecdotally, we found the labor algorithm has worked the best. For success with alternative methods, it is important to have equipment available such as peanut balls, cubies, and the right kinds of bolsters and pillows for positioning. Overall, the project enculturated C-section alternatives, which helped the unit rapidly decrease C-section rates.
Document Type
Poster
Publication Date
11-15-2023
Promoting vaginal birth in the nulliparous term singleton vertex (NTSV) patient
Background
Cesarean section (C-section) delivery can be a lifesaving procedure but is overused and can also be dangerous. Improvements focused on ‘first births’ (nulliparous, term, singleton, vertex (NTSV) deliveries) help prevent repeat C-sections.
Local Problem
The C-section rate for NTSV births in the Labor and Delivery (L&D) unit at a large, urban, Level 1 trauma center was 31.9% in January 2022, indicating C-section overuse and initiating a a unit goal to reduce the rate.
Method
We shared current C-section rates, required computer-based training modules about C-sections and vaginal births, discussed vaginal versus C-section criteria for each patient during morning huddles, rolled-out a pre-C-section checklist with C-section prevention algorithms used during labor, and educated nurses about alternative methods to prevent C-sections. Alternative methods included early labor ambulation using wireless monitors, ‘spinning babies’ classes, and a ‘promoting vaginal birth (PBV)’ newsletter featuring success stories and a ‘position of the month.’ Nurses with successful NTSV deliveries were recognized with a stork charm for their uniform and using online recognitions.
Results
From January 2022 year to March 2023, the unit reduced C-section rates for NTSV patients from 31.9% to 27.2%
Implications for Practice
This project employed many different methods at one time, so evaluating the effectiveness of each is a challenge. Anecdotally, we found the labor algorithm has worked the best. For success with alternative methods, it is important to have equipment available such as peanut balls, cubies, and the right kinds of bolsters and pillows for positioning. Overall, the project enculturated C-section alternatives, which helped the unit rapidly decrease C-section rates.
Affiliations
Advocate Christ Medical Center