Safely Averting NTSV Cesarean Births
Background
OBI is working with 70+ hospital teams in Michigan to support physiologic birth, offer more equitable, respectful care, and prevent unnecessary cesarean births.
The Problem
The national Nulliparous Term Singleton Vertex (NTSV) cesarean rate is high and varies substantially across hospitals. The NTSV cesarean rate in Michigan is significantly higher than the national average.
23.6%
Healthy People 2030 NTSV Cesarean rate goal
28%
Michigan’s average NTSV cesarean rate
11-41%
Variation in NTSV cesarean rate in Michigan hospitals
Aim
By December 2025, 50% of participating hospitals will achieve their NTSV cesarean goal.
Goals
- Increase the percent of NTSV cesarean births for dystocia that meet ACOG/SMFM criteria
- Increase the percent of NTSV cesarean births for abnormal/indeterminate fetal heart rate tracing that have documentation of management with an algorithm
- 70% of participating hospitals have a process for NTSV cesarean case review
- Reduce the percent of participating hospitals with an NTSV cesarean rate over 30%
- Increase the number of participating hospitals with an NTSV cesarean rate below the HP2030 target of 23.6%
Implementation Resources
Initiative Background
Clinical Guidance for Labor Dystocia
- Labor Dystocia Criteria Chart
- Labor Dystocia Publications
- Doing the Dance with Dystocia. Presented by Lisa Kane Low, PhD, CNM, FACNM, FAAN. OBI Webinar Series, April 2024. (OBI Members Only) View the Recording & Slides.
Clinical Guidance for Management of Category II Fetal Heart Tracings (FHTs)
- Management of Category II Fetal Heart Tracings (FHTs) Publications
- Electronic Fetal Monitoring: A Standardized Approach. Presented by Rebecca L. Cypher, MSN, PNNP. OBI Webinar Series, March 2022. (OBI Members Only) View the Recording & Slides.
QI Planning & Implementation Tools
OBI 2023 Site Visit Summary Report: Barriers, Facilitators, & Strategies for Safely Lowering the NTSV Cesarean Rate
- OBI 2023 Site Visit Summary Report: Barriers, Facilitators, & Strategies for Safely Lowering the NTSV Cesarean Rate: This report is designed for individuals leading quality improvement (QI) efforts to safely lower the NTSV cesarean rate. The goal of this report is to help QI champions measure barriers and facilitators to safely lower the NTSV cesarean rate and link barriers/facilitators to QI strategies that will promote successful clinical practice change. We invite you to carve out time to read and reflect on this report and discuss key findings with your OBI Champion Team.
- Self-Assessment for Barriers to Safely Lowering the NTSV Cesarean Rate: This self-assessment, abstracted from the OBI 2023 Site Visit Summary Report, is designed to help quality improvement (QI) champions identify local barriers to safely lowering the NTSV cesarean rate.
- Strategies Checklist for Safely Lowering the NTSV Cesarean Rate: This checklist, abstracted from the OBI 2023 Site Visit Summary Report, is designed to help quality improvement (QI) champions link barriers/facilitators to QI strategies that will promote successful clinical practice change efforts to safely lower the NTSV cesarean rate.
EHR Templates
Pre-Cesarean Checklist for Labor Dystocia or Failed Induction
Pre-Cesarean Checklist for Labor Dystocia or Failed Induction. California Maternal Quality Care Collaborative (CMQCC). 2016.
OBI Category II Fetal Heart Rate Tracing Management Algorithm
OBI Category II Fetal Heart Rate Tracing Management Algorithm. February 2024.
Clinician Engagement
OBI Criteria Badge Buddy
A two-sided, 4”x 3” inch badge buddy that can be used as a fast reference reminder for Labor Dystocia compliance criteria and Category II FHR monitoring interventions.
Consider printing these for all members of your clinical team!
Training Slide Deck Template
Coming soon!
Moving our Mamas (MOMs) Labor Support Training
To host a hands-on labor support training class for your maternity care staff, please contact Patricia Klassa MSN, RN, CNS-C, IBCLC (pklassa@comcast.net) and Cheryl (Larry-Osman) Bellamy DNP, BS, APRN, CNM, CNS-C, C-EFM (cheryl9800@gmail.com).
Patient Engagement
Labor Support Guide
Use this guide to identify, discuss, and select options for labor support with your team.
Coping with Labor Algorithm
QI Evaluation
NTSV Performance Report Manual
A manual to help OBI Champions understand their Push Reports with tips for interpretation & action items.
Sample NTSV Performance Report
Risk-Adjustment & O:E Ratios: A Primer
A brief explanation of how OBI uses risk adjustment and O:E ratios in assessing hospital NTSV Cesarean performance.
Case Reviews
Background
- NTSV Case Review Primer: Helps Obstetrics Initiative (OBI) champions introduce frontline clinicians to the NTSV Case Review process.
- NTSV Case Reviews. Presented by Stephanie Ludlow, BSN, RN, and Denise Parrish, MSN, RN, RNC-OB. 2024 OBI Webinar Series, January, 2024. (OBI Members Only) View Recording & Slides.
- (Coming Soon!) NTSV Case Review FAQ
Tools for Conducting Case Reviews
- NTSV Case Review Worksheets: Champions can use these worksheets to evaluate practices, determine opportunities, and recognize excellent care. Edit as needed for your site.
- NTSV Case Review Tracking Template: A template spreadsheet that NTSV Case Review Committees can use internally to track cases reviewed and decisions made. Please do not submit this form to the Coordinating Center to obtain P4P points (you may submit the OBI NTSV Cesarean Case Review Unit Dissemination Form below).
Tools for Dissemination of Case Review Findings
- NTSV Case Review Decision Letter: Designed to help OBI Champions communicate the specific findings of an NTSV Case Review to the clinicians involved in that case.
- OBI NTSV Cesarean Case Review Unit Dissemination Form: Champions can use this template to share individual case review findings with all unit staff, and with the OBI Coordinating Center to obtain points for Measure 4 of the 2024 OBI P4P Scorecard. Edit as needed for your site.
- NTSV Case Review Aggregate Findings Dissemination Form: Champions can use this template to share aggregate case review findings with all unit staff. Edit as needed for your site.