Ascension Health developing best methods to reduce or eliminate birth complications

April 1, 2011

Simulator gives care teams practice responding in crisis

The vast majority of mothers in the U.S. give birth with no serious complications. But sometimes, things do go wrong in the delivery room.

By looking at the childbirth experiences of up to 40,000 mothers over the next three years, Ascension Health wants to determine the best methods to reduce or eliminate birth complications.

Ascension Health got a $2.9 million federal grant from the Agency for Healthcare Research and Quality to support the Excellence in Obstetrics project. Five of the St. Louis-based health system's hospitals will participate. Although it already has an extremely low birth trauma rate compared to the national average, Ascension Health wants to reduce that rate to zero, says Ann Hendrich, the project's principal investigator and a vice president of clinical excellence operations for Ascension Health.

"We believe the Excellence in Obstetrics demonstration project will help save the lives of mothers and their babies by improving safety in the birthing process," says Hendrich.

Shoulder dystocia
One part of the study will look closely at a rare but often unpredictable and potentially serious childbirth complication known as shoulder dystocia, in which the baby's shoulders fail to deliver after the head, in effect getting stuck in the birth canal.

Shoulder dystocia can cause problems for both mother and infant. It can lead to bleeding and uterine lacerations in the mother. In the baby, it can result in fractures to arms and collarbones, or worse, paralysis of the shoulder, arm or hand. It can even cause death when the umbilical cord is compressed between the fetus and birth canal.

Although there appear to be some risk factors, such as the weight of the baby and mother, shoulder dystocia is difficult to manage because the vast majority of cases occur without warning. Studies show it appears in 5 to 9 percent of births in which the baby weighs nearly 9 pounds or more. But it also can occur with much smaller babies, and doctors don't really know why it happens in some births and not others.

"The research around this is still fairly small, and that's why we're doing this study," says Hendrich.

The project also will examine the teamwork between nurses and doctors when fetal monitors detect a crisis during delivery, says Hendrich. Such teamwork is crucial because doctors and nurses must react quickly when problems occur during delivery.

"We want to make sure if there are signals the infant is not tolerating labor well, that there is an immediate escalation between the physician and nurse," says Hendrich.

Rainbow babies
As part of the study, Ascension Health plans to evaluate the medical records of 30,000 to 40,000 mothers in five hospitals: Sacred Heart Hospital on the Emerald Coast in Miramar Beach, Fla., St. Vincent's Birmingham in Birmingham, Ala.; St. John Hospital and Medical Center in Detroit; Columbia St. Mary's in Milwaukee; and Saint Agnes Hospital in Baltimore.

Doctors at these sites are asking patients during prenatal visits for their permission to evaluate their medical records following childbirth, and nurses have been trained on how to take informed consent, said Hendrich.

More than eight out of 10 women approached in the early weeks of the study have agreed to participate — a far better response rate than is typical for clinical trials — which often average less than 20 percent, says Hendrich.

"We're hoping to enroll every mother we can," she said. "We're just thrilled that mothers see the opportunity."

Ascension Health also wanted to make the mothers' study as diverse and inclusive as possible. All patient materials were translated into 10 languages, ranging from Arabic and Spanish to Korean and Russian.

"Even if there was only going to be two Burmese-speaking mothers in this study, we had a consent form so that they could participate," said Hendrich. 

Simulating complications
The project will study the effectiveness of a team approach to childbirth, which involves doctors and nurses trained together. Part of the training at all five hospitals in the study will involve using a mannequin with a small memory chip that not only simulates childbirth, but also simulates problems such as shoulder dystocia, says Hendrich.

She compares the process to airline pilots who routinely train how to react during a crisis. Although long used in the airline business, simulation training is fairly new in health care, particularly training using computer-driven mannequins, Hendrich said.

"With simulation training, you get to experience the crisis before you've actually experienced it," she says, adding that Ascension Health was one of the first hospitals in the country to use the mannequins in perinatal training of medical staff. 

Full disclosure
The project also will train doctors on how to communicate with patients after a medical error or birth complication. That response will be based on full disclosure to patients on what happened during delivery, "on what went well and what didn't go well," says Hendrich. "If we have fault, we disclose that to the mother."

The approach also calls for a quick resolution of a claim against the hospital when the hospital has determined it was at fault, rather than a long drawn-out court fight that often lasts years.

"We want to remove that and do the right thing," says Hendrich. "We believe that patients have a right to know what happened."

If the study proves that Ascension Health's team-style approach and training methods are successful in reducing birth trauma, then Ascension Health plans to incorporate those methods into other hospitals and clinical practices across the health system and eventually, to share the information with other hospitals across the U.S., says Hendrich. Ascension Health has facilities in 20 states and the District of Columbia.

Hendrich says the study is central to Ascension Health's mission of providing holistic care that improves the health of individuals and communities.

 

Copyright © 2011 by the Catholic Health Association of the United States
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