Promoting Vaginal Birth
60%
The increase in national C-Section rates from 1996 to 2011.
23.6%
The Healthy People 2030 NTSV C-Section rate goal.
11-44%
The range of NTSV C-Section rates among Illinois hospitals in 2017.
Supporting vaginal birth and reducing primary cesareans for optimal maternal and neonatal outcomes
Working with hospital-based teams, the Illinois Perinatal Quality Collaborative (ILPQC) launched launching a statewide obstetric initiative to implement American College of Obstetricians and Gynecologists and Alliance for Innovation on Maternal Health guidelines. ILPQC is working with hospital teams to implement key quality improvement (QI) strategies such as facilitating clinical culture change that promotes and supports vaginal birth; developing standardized processes for induction and labor support; and developing standardized protocols for identification and response to labor challenges/abnormalities.
Objectives:
-
AIM:
70% of participating hospitals will be at or below the Healthy People goal of 23.6% cesarean delivery rate among NTSV births by December 31, 2022
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GOAL:
Increase the percent of cesarean section deliveries among NTSV births that meet ACOG/SMFM criteria for cesarean
-
GOAL:
Increase the percent of physicians/midwives/nurses educated on ACOG/SMFM criteria for cesarean, labor management strategies/response to labor challenges, protocol for facilitating decision huddles and/or decision debriefs
Labor Support Toolbox
Labor Management Support E-Modules
Labor Support Slides and Materials
Staff education videos
National Guidance: ACOG and AWOHNN
ACOG Committee Opinions/Practice Advisory
- ACOG/SMFM Obstetric Care Consensus #1: Safe Prevention of the Primary Cesarean Delivery
- ACOG Committee Opinion #490: Partnering with Patients to Improve Safety
- ACOG Committee Opinion #766: Approaches to Limit Intervention during Labor and Birth
- AWHONN: National Partnership for Maternity Safety Consensus Bundle
AWOHNN Statements
Labor Management Tools
Labor Support and Pain Management
- Implement Intermittent Fetal Monitoring Policies for Low-Risk Women- from CWQCC
- Choosing Positions for Labor and Birth
- Optimal Labor Positions Guide- from CMQCC
- Childbirth Connection Labor Pain
- Best Practices for Epidurals- from CMQCC
First Stage
- Admission in Latent (Early Labor) without Medical Indication- from CMQCC
- Coping with Labor Algorithm
- Labor Duration Guidelines- from CMQCC
Second Stage
- Algorithm for Management of Second Stage of Labor- from CMQCC
- Second Stage Management of Malposition- from CMQCC
- Active Labor Partogram- from CMQCC
- Lamaze Healthy Birth Practice #5: Avoid Giving Birth on Your Back and Follow Your Body’s Urge to Push
- Utilize Operative Vaginal Delivery for Eligible Cases- from CMQCC
Resources for Doulas/About Doulas
Standardization of Policy Protocols, Guidelines, and Algorithms
Labor and Delivery Admission and Early Labor
- Birth Preference Worksheet- from CMQCC
- Admission in Latent (Early Labor) without Medical Indication
- Admission Discussion Guide- from Ariadne Labs
Labor Challenges
Toolkit
Sustainability
Introduction
Initiative Resources
- 10 Steps to Getting Started with the ILPQC Promoting Vaginal Birth Initiative (Updated 11/12)
- Promoting Vaginal Birth June/July Meeting Agenda (3/3)
- PVB 3 Key Opportunities for Improvement
- Promoting Vaginal Birth Aims and Measures (Updated)
- Promoting Vaginal Birth Data Form (Updated 3/1/21)
- Promoting Vaginal Birth Hospital-Level Measures Data Form (Updated 4.11.22)
- PVB Data Collection Commonly Asked Questions (Updated 3/3)
- PVB Data Collection Tool: Process Flows
- Promoting Vaginal Birth Drivers Diagram
- Promoting Vaginal Birth Readiness Survey
- CMQCC Audit Worksheet
- Plan-Do-Study-Act Worksheet
- 30-60-90 Day Template
Labor Culture Survey Resources
Promoting Vaginal Birth Slide Set
- CMQCC Slide Set
- FPQC Slide Set
- ILPQC Grand Rounds- COMING SOON
National Guidance: AIM Bundle
National Guidance: ACOG and AWOHNN
ACOG Committee Opinions/Practice Advisory
- ACOG/SMFM Obstetric Care Consensus #1: Safe Prevention of the Primary Cesarean Delivery
- ACOG Committee Opinion #490: Partnering with Patients to Improve Safety
- ACOG Committee Opinion #766: Approaches to Limit Intervention during Labor and Birth
- AWHONN: National Partnership for Maternity Safety Consensus Bundle
AWOHNN Statements
Creating Clinical Culture Change
QI Team Strategies
- Create Highly Reliable Teams and Improve Interdisciplinary Communication- Section 1
- P. Lee King, D. Young, A. Borders, “A Framework to Harness the Power of Quality Collaboratives to Improve Perinatal Outcomes
Provider and Nurse Education Materials
- *NEW* ILPQC PVB NTSV Fallout Review
- Current Landscape of Cesarean Sections in Illinois
- Guidance for Understanding and Unblinding Provider Level NTV Cesarean Rates at Start of Project- from CMQCC
- ACOG Key Labor Definitions- from CMQCC
- Six is the New Four- ACOG OB Care Consensus
- CMQCC Labor Duration Guidelines
- CMQCC Webinar: Induction of Labor- Risk, Benefits, and Techniques for Increasing Success
- Video of Safe Deliveries Roadmap with AIM
- Denver Health Intermittent Monitoring Slide Set
- Response to Arrive Trial- from CMQCC
- Lamaze aligns with ACOG
- Shared Decision Making
Patient Education
- NEW Sparrow Hospital Labor Partnership Agreement Booklet
- NEW Sparrow Hospital Labor Partnership Patient Form
- Patient Education Pages- from CMQCC
- My Birth Matters: C-Section Consumer Eduction Campaign- from California Health Care Foundation with CMQCC
- Printable patient education materials
Clinical Debriefs
- *NEW* ILPQC ACOG/SMFM Guidelines
Checklist for Labor Dystocia & Arrest - *NEW* CMQCC Providence St. Joseph Fallout review form
- Hackensack Meridian Health Sample Pre-Cesarean Checklist and Team Huddle Form- from FPQC
- Tampa General Pre-cesarean Huddle form- from FPQC
- Pre-Cesarean Checklist for Labor Dystocia or Failed Induction- from CMQCC
- E. White VanGompel, E. Main, D. Tancredi, J. Melnikow, “BMC Pregnancy and Childbirth: Do provider birth attitudes influence cesarean delivery rate: a cross sectional study”
Labor Management Tools
Labor Support and Pain Management
- *NEW* ILPQC Labor Management Support E-Modules
- Implement Intermittent Fetal Monitoring Policies for Low-Risk Women- from CWQCC
- Choosing Positions for Labor and Birth
- Optimal Labor Positions Guide- from CMQCC
- Childbirth Connection Labor Pain
- Best Practices for Epidurals- from CMQCC
First Stage
- Admission in Latent (Early Labor) without Medical Indication- from CMQCC
- Coping with Labor Algorithm
- Labor Duration Guidelines- from CMQCC
- ILPQC Labor Management Strategies/Response for Labor Challenges Training Options- COMING SOON
Second Stage
- Algorithm for Management of Second Stage of Labor- from CMQCC
- Second Stage Management of Malposition- from CMQCC
- Active Labor Partogram- from CMQCC
- Lamaze Healthy Birth Practice #5: Avoid Giving Birth on Your Back and Follow Your Body’s Urge to Push
- Utilize Operative Vaginal Delivery for Eligible Cases- from CMQCC
Resources for Doulas/About Doulas
Standardization of Policy Protocols, Guidelines, and Algorithms
Labor and Delivery Admission and Early Labor
- Birth Preference Worksheet- from CMQCC
- Admission in Latent (Early Labor) without Medical Indication
- Admission Discussion Guide- from Ariadne Labs
Induction
- Implement Policies for Safe Use of Oxytocin- from CMQCC
- Induction of Labor Algorithm- from FPQC
- SAMPLE Induction Consent
- SAMPLE Induction of Labor Checklist- from FPQC
- AWHONN Position Statement: Non-Medically Indicated Induction and Augmentation of Labor
- ACOG Patient Safety Checklist #5: Scheduling Induction of Labor
- ACOG Practice Bulletin #107: Induction of Labor
- AJOG Implementation of a Conservative Checklist- Based Protocol for Oxytocin Administration Maternal and Newborn Outcomes
- IHI Improvement Map: Perinatal Augmentation Safety
- ILPQC Process Flow ACOG/SMFM Criteria: Induction
- Lee Health Induction Scheduling Policy
- CGH Induction Consent with built-in checklist
Labor Challenges
- Labor Dystocia Checklist
- Spontaneous Labor Algorithm Arrests/Dystocia- from FPQC
- ACOG Committee Opinion #766: Approaches to Limit Intervention during Labor and Birth
- Assisted Delivery Discussion Aid- from Ariadne Labs
- ILPQC Process Flow ACOG/SMFM Criteria: Labor Dystocia
Fetal Intolerance
- ACOG Practice Bulletin #116: Management of Intrapartum Fetal Heart Rate Tracings
- Algorithm for Management of Category II Fetal Heart Rate Tracings- from CMQCC
- Algorithm for the Management of Intrapartum Fetal Heart Rate Tracings- from CMQCC
- Management of Fetal Heart Rate Tracings- from FPQC
- ACOG Practice Bulletin #106: Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles
- AJOG Clinical Opinion: Intrapartum Management Principles of Category II Fetal Heart Rate Tracings: Towards Standardization of Care
- AWHONN Position Statement: Fetal Heart Monitoring
- ILPQC Process Flow ACOG/SMFM Criteria: Fetal Heart Rate Concerns
The following material is an example only and not meant to be prescriptive. The resources provided in this toolkit are for informational purposes only. The exclusion of a resource, program, or website does not reflect the quality of that resource, program or website. Note: websites and URLs are subject to change.
Webinars
2024 Sustainability Webinars
January 2024: Sustainability Webinar (View Slides here)
2023 Webinars
January 2023: Provider and Nurse Buy-In (View Recording Here)
February 2023: Small group discussions strategies for success (View Recording Here)
March 2023: Reviewing your PVB Data Stratified by Race, Ethnicity and Insurance Status (View Recording Here)
April 2023: Small Group Coaching and Breakout Sessions
June 2023: Improving Failed Inductions Meeting ACOG/SMFM Criteria (View Recording Here)
July 2023: Achieving QI Excellence (View Recording Here)
August 2023: Small Group Breakout Session by Perinatal Network (View Recording Here)
September 2023: Small Group Breakout Session by Perinatal Level (View Recording Here)
November 2023: Preparing for 2024 (View Recording Here)
2022 Webinars
January 2022: Un-blinding Provider-level NTSV C-section Rates (View Recording Here)
February 2022: Second Stage Arrest (View Recording Here)
March 2022: Shared Decision Making and Patient Education (View Recording Here)
April 2022: Key Strategies for Getting across the Finish Line (View Recording Here)
June 2022: Getting to Green: Key PVB Structure Measures (View Recording Here)
July 2022: Second Stage Arrest and Dystocia Management Strategies (View Recording Here)
August 2022: Patient Education and Shared Decision Making (View Recording Here)
September 2022: Individual NTSV C-Section Fallout Case Review (View Recording Here)
November 2022: 2022 Annual Conference Recap & NTSV C-Section Fallouts (View Recording Here)
2021 Webinars
Promoting Vaginal Birth Launch Call Recording: Slides available here
January 2021: The Labor Culture Survey(View Recording here)
February 2021: Creating Buy-In (View Recording here)
March 2021: Incorporating ACOG/SMFM Guidelines for Cesarean Delivery (View Recording here)
April 2021: Utilizing Cesarean Delivery decision huddles and checklists (View Recording here)
June 2021: Unpacking your Labor Culture Survey Results (View Recording here)
July 2021: Implementing standardized protocol/processes for induction (View Recording Here)
August 2021: Systems changes for induction processes and protocols (View Recording Here)
September 2021:Implementing standard criteria for the diagnosis of labor dystocia arrest disorders (View Recording here)
November 2021: Policies and Procedures for Pain management and early Labor (View Recording Here)