This article appeared in HealthLeaders Media on August 1, 2017.
By Jennifer Thew
The perinatal director at SSM St. Mary’s Hospital shares how the organization achieves C-section rates well below the national average.
Patience is a virtue—especially when it comes to achieving low C-section rates.
“Presence and patience,” says Pam Lesser, RNC-AWH, MSN, director, perinatal services, at SSM Health St. Mary’s Hospital–St. Louis.
“We need to support women and be present and available to them to help them have the birth they want but also keep things safe. Then we also need to be patient enough to say, ‘If everything’s looking fine, there’s no reason to be moving ahead to any decisions here. We can sit and watch a little longer, and we can try a couple of different things.”
This go-with-the flow philosophy seems to be paying off for St. Mary’s Hospital.
The U.S. Department of Health and Human Services’ national benchmark is 23.9% for low-risk births.
Nursing Presence and Support
There are many things that go into creating an environment that keeps C-section rates in check. The standard course of care at St. Mary’s Hospital includes no elective inductions before 39 weeks of gestation, avoiding unnecessary elective inductions, and not putting time limits on deliveries.
“If the baby is looking fine and tolerating what’s going on and you’ve got the mom that you’re supporting who’s in it for the long haul, we have a team that is comfortable with just waiting on what, hopefully, is its natural progression,” Lesser says.
The facility has also worked hard to ensure staffing comes as close as possible to the Association of Women’s Health, Obstetric and Neonatal Nurses’ guidelines for care, which means one-to-one nursing care for actively laboring patients.
“That presence of the nurse to be able to support the mom in whatever kind of birth she’s choosing is important,” Lesser says. “[It] gives [the mom] the time and the support to get where she wants to be.”
Communication and Patient Safety
Communication is also essential to St. Mary Hospital’s C-section rate success. The organization has done a great deal of work around safety and communication using AHRQ’s TeamSTEPPS model.
“Everyone who works here is trained in that, but we really reinforce the importance of huddles, briefs, and debriefs to keep us all on the same page,” Lesser says.
The goal of these communications is to keep care patient-centered yet safe.
“We do bedside handoffs with nurses so that the patient is included,” she says. “Every shift we’re updating and asking, ‘Does this sound right? Are we on the right course for what you’re wanting?'” she explains.
Additionally, the charge nurses lead a team review (nurses, obstetricians, neonatologists, and anesthesiologists) of the care management plan of every patient in labor and delivery. They discuss whether they are on track with the plan and what needs to be addressed or adjusted.
“We come together and look at the data we have—be it the patient experience, vital signs, or monitor strips,” Lesser says. “[We discuss] the best way we can go to move forward to help the mother achieve what she wants and what we know is safest, which is a vaginal birth if all else is looking OK.”