Did You Know?
Stakeholders across the state and the U.S. have begun to take note of cesarean delivery rates, including their impact on morbidity, mortality, and health care costs.
The goal of the PROVIDE Initiative is to improve maternal and newborn outcomes by applying evidence-based interventions to promote primary vaginal deliveries at Florida delivery hospitals and ultimately reduce NTSV cesareans.
An analysis of Florida birth certificates showed only one-fifth of the hospitals (21%) meet the Healthy People 2020 national goal for Nulliparous Term Singleton Vertex (NTSV) cesarean section deliveries of 23.9% or less. The primary cesarean delivery rate, which drives the overall cesarean rate, among low-risk first-birth deliveries in Florida ranges from 7.35% to 59.8%. Wide variation suggests clinical practice patterns may contribute and provides an opportunity for improvement.
This Tool Box contains tool kit documents, algorithms, example policies and educational materials, and more. This resource is updated regularly throughout the project.
Newly Added Tool Box Resources:
The FPQC is hard at work creating a library of short videos for the PROVIDE Initiative. Check back for additions!
Julie DeCesare, MD, clinical co-lead of the Florida Perinatal Quality Collaborative's Promoting Primary Vaginal Deliveries (PROVIDE) Initiative, discusses the ARRIVE Trial, and whether or not this should change practice and care in Florida. FPQC Statement on the ARRIVE Trial findings and PROVIDE: https://tinyurl.com/FPQCarrive
Dr. Karen Bruder, clinical co-lead of the Florida Perinatal Quality Collaborative's Promoting Primary Vaginal Deliveries (PROVIDE) Initiative, discusses tips for engaging physicians in your quality improvement project.
Research shows that use of a peanut ball in labor results in shortened length of labor, and reduced cesarean section rate in epidural patients. We'll walk you through some positions with the peanut ball in the first and second stage of labor. Jessica Brumley, CNM, PhD leads the FPQC's Labor Support Skills to Promote Vaginal Birth Workshops.
Knowing some techniques to rotate a malpositioned baby can help avoid a cesarean. The Miles Circuit is a series of positions that are useful to help get the baby lined up in the Left Occiput Anterior (LOA) Position. Jessica Brumley, CNM, PhD leads the FPQC's Labor Support Skills to Promote Vaginal Birth Workshops.
Why does changing positions during labor help deliver a baby vaginally? Jessica Brumley, CNM, PhD leads the FPQC's Labor Support Skills to Promote Vaginal Birth Workshops.
Cesarean Rates: What's with all the different types? How are they calculated? Why should we focus on NTSV cesarean rates? Dr. Bill Sappenfield, MD, MPH explains what all the rates mean and why the PROVIDE Initiative focuses on NTSV cesareans.
Let's all get on the same page when it comes to definitions of: - When active labor begins - Induction vs. augmentation - First stage arrest, second stage arrest, and failed induction Dr. Wilbur Hitt shares the standard definitions used by ACOG and the Florida Perinatal Quality Collaborative.
These can be used in a variety of ways! Here are some ideas:
Advent Health Waterman
Advent Health Zephyrhills
AdventHealth Daytona Beach
AdventHealth Wesley Chapel
AdventHealth Winter Park
Ascension Sacred Heart Hospital on the Emerald Coast
Ascension St. Vincent's Clay County
Ascension St. Vincent's Riverside
Ascension St. Vincent's Southside
Baptist Medical Center Beaches
Baptist Medical Center Nassau
Baptist Medical Center South
Bayfront Health Spring Hill
Bayfront Health St. Petersburg Baby Place
Bethesda Hospital Inc.
Boca Raton Regional Hospital
Broward Health Medical Center
Cape Coral Hospital (Lee Health)
Lakeland Regional Hospital
Leesburg Regional Medical Center
Cleveland Clinic Indian River Hospital
Cleveland Clinic Tradition Hospital (Tradition Medical Center)
Fort Walton Beach Medical Center
Halifax Health Medical Center
HealthPark Medical Center (Lee Health)
Baptist Health South Florida
Jackson North Medical Center
Jackson South Medical Center
JFK Medical Center
Jupiter Medical Center
Kendall Regional Medical Center
Lawnwood Regional Medical
Manatee Memorial Hospital
Mease Countryside Hospital (BayCare)
Memorial Hospital Miramar
Memorial Hospital West
Memorial Regional Hospital
Mercy Hospital (Plantation General Hospital)
Morton Plant Hospital (BayCare)
Mount Sinai Medical Center
Naples Community Hospital
North Florida Regional Medical Center
North Shore Medical Center
Northwest Medical Center
Orange Park Medical Center
Palmetto General Hospital
Palms West Hospital
Parrish Medical Center
Plantation General Hospital
Sacred Heart Hospital Pensacola
Santa Rosa Medical Center
Sarasota Memorial Healthcare System
South Florida Baptist Hospital (BayCare)
South Lake Hospital
South Miami Hospital
St. Joseph's Hospital North (BayCare)
St. Joseph's Hospital South (BayCare)
St. Joseph's Women's Hospital (BayCare)
St. Lucie Medical Center
St. Mary's Medical Center
Tallahassee Memorial Healthcare
Tampa General Hospital
The Women's Hospital at Jackson Memorial Medical Center
UF Health Jacksonville
Wellington Regional Medical Center
West Kendall Baptist Hospital
Winnie Palmer Hospital for Women and Babies
Winter Haven Women's Hospital (BayCare)
May 9, 2019 - PROVIDE 2.0: The Next Generation
April 11, 2019 - Change Management and PROVIDE 2.0
February 14, 2019 - Where We Are, Where We Are Going, and Managing the OP Baby
December 13, 2018 - The Safety and Benefits of Outpatient Cervical Ripening
October 11, 2018 - Improving and Sharing Data
August 9, 2018 - The Early Labor Walking Path: A Tool to Reduce Admission in Early Labor and Reduce Primary Cesarean Section
June 14, 2018 - Second Stage of Labor: Push it Real Good
May 10, 2018 - Intermittent Auscultation for Low Risk Women
March 8, 2018 - Lessons Learned from Implementing an Induction Policy
February 8, 2018 - Overcoming Resistance to Change
November 9, 2017 - Finding Your Cesarean Reduction Opportunities (PROVIDE Data)
For most low-risk nulliparous, term, singleton, vertex (NTSV) pregnancies, cesarean birth increases risk of hemorrhage, infection, uterine rupture, abnormal placentation, cardiac events, psychological stress, longer hospital stays, increased pain, and increased postpartum re-admissions. Cerebral palsy and neonatal seizure rates have remained unchanged since 1980. Cesareans are associated with impaired neonatal respiratory function, neonatal intensive care unit admission, difficulty breastfeeding, and lifelong health (Main et al 2011; Smith et al 2016).
Costs associated with cesareans are significant for insurers, government, taxpayers, and consumers. Studies have shown that each cesarean costs $5,000 to $10,000 more than a vaginal birth. Based on Florida reports, maternal hospital cost savings for each Medicaid and private insurance cesarean delivery would be about $4,000. Primary cesarean deliveries are a major contributor to the large increase in cesarean delivery rates in the United States over the past two decades.
Participation in this initiative helps hospitals work in a collaborative with resources to help you implement evidence-based quality improvement recommendations. It also offers an environment to learn together with others on the best strategies, methods and tools to adapt and implement. Hospitals that participate in multi-organization quality improvement collaboratives achieve more gains faster than those who do so alone. Past participants have found it useful to not have to “reinvent the wheel.”