SIVB Extranet

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SIVB Team Resources:

Phase III


SIVB Phase III Team Roster form - must be completed to participate in Phase III

SIVB Phase III Data Collection Form - PDF version   DOC version

SIVB Phase III Data Dictionary

SIVB Phase III Report Instructions - Instructions for running reports of your data

SIVB Phase III RCA form - revised 12/03/2012: Root cause analysis for C-section

SIVB Sample Letter for OBs regarding C-section rate - thanks to Rex Hospital for sharing


Phase II

SIVB Phase II Team Roster form - must be completed to participate in Phase II

SIVB Phase II Data Collection Form - PDF version   DOC version

SIVB Phase II Data Dictionary

SIVB Phase II Report Instructions - Instructions for running reports of your data

Phase I

SIVB Data Collection Form - REVISED June 2011

SIVB Data Collection Form

SIVB Data Collection Form - PDF

SIVB Data Definitions

SIVB Data Sampling Plan

SIVB Data PowerPoint - review of important things to remember for data collection

SIVB Team Worksheet - Developing an action plan for the Supporting Intended Vaginal Birth initiative - “Buckets” of work for improving approaches to induction of labor

Joint Commision Perinatal Core Measure PC-02

SIVB Team goals and objectives - Developing an Action Plan for the Supporting Intended Vaginal Birth Initiative - compilation of individual team goals and objectives

SIVB - the Patient Perspective - Patient and Family Perspectives and their connection to Increasing the Vaginal Birth Rate

SIVB - PubMed - citations of interest


SIVB Data:

SIVB Aggregate Data through December 31 2010

Trends in Cesarean Delivery Rates for North Carolina Live Births - Statistical brief available from the State Center for Health Statistics. This report examines trends in the rates, or percentages, of Cesarean deliveries for North Carolina resident live births.


SIVB Posters

Should I Stay or Should I Go?

Raise Your Hand If You Want A C-Section

Not in Labor? Stay Home!

Provider Poster


SIVB Webinars:

Phase II

February 26 2013 - Obesity

January 22 2013 - The Art of Triage

November 12 2012 - Forsyth review of C-section RCA tool

September 25 2012

August 28, 2012 - Birth Certificate Data

April 24, 2012 - Supporting Intended Vaginal Birth - A Community Hospital’s Approach  (the spreadsheets referenced on the webinar are included below should you wish to adapt them for your own use - questions on how to use the spreadsheet should be sent here)

March 27, 2012 - SIVB I data of interest, SIVB II markers of successful work

February 28, 2012 - SIVB Phase I wrap-up and Starting SIVB Phase II

Phase I

February 22 2011 Webinar - including cervical ripening discussion

February 22 2011 Webinar - Oral Misoprostol papers

  1. Oral Misoprostol and Vaginal Isosorbide Mononitrate for Labor Induction - The addition of vaginal isosorbide mononitrate to oral misoprostol for cervical ripening and labor induction did not reduce time to vaginal delivery and was associated with a greater incidence of headache.
  2. Prospective randomized clinical trial of inpatient cervical ripening with stepwise oral misoprostol vs vaginal misoprostol - Stepwise oral misoprostol (50 mg followed by 100 mg) appears to be as effective as vaginal misoprostol (25 mg) for cervical ripening with a low incidence of hyperstimulation, no increase in side effects, a high rate of patient satisfaction, and is associated with a lower cesarean section rate.
  3. Low-Dose Oral Misoprostol for Induction of Labor: A Systematic Review - Low-dose oral misoprostol solution (20 micrograms) administered every 2 hours seems at least as effective as both vaginal dinoprostone and vaginal misoprostol, with lower rates of cesarean delivery and uterine hyperstimulation, respectively.
  4. Oral Versus Vaginal Misoprostol for Labor Induction - These findings indicate that, in a closely supervised hospital setting with adequate monitoring, oral misoprostol has the potential to induce labor as safely and effectively as its vaginal analogue.

March 22 2011 Webinar

May 24 2011 Webinar

  1. Leigh Ann Joel, CNM, Women's Birth and Wellness Center in Chapel Hill: Discussion of strategies from the midwifery model of care to increase the likelihood of vaginal birth.    PowerPoint   PDF   Audio
  2. Celeste Milton, RN, BSN, MPH, Associate Project Director at The Joint Commission working on the Perinatal Care measure set:  Discussion of the first year of the new Perinatal Care measures, what the first two quarters of data are showing, and how TJC continues to refine these measures.    PowerPoint   PDF  Audio
  3. Jessica Phipps, PQCNC: Data update –induction of labor and cervical ripening PowerPoint   PDF


SIVB Evidence Base:

  1. ACOG Practice Bulletin: Dystocia and Augmentation of Labor - review of the definition of dystocia, risk factors associated with dystocia, the criteria that require delivery, and approaches to clinical management of labor complicated by dystocia - not available at ACOG's request
  2. ACOG Practice Bulletin: Induction of labor - review current methods for cervical ripening and induction of labor and summarize the effectiveness of these approaches - not available at ACOG's request
  3. ACOG Practice Bulletin: Intrapartum Fetal Heart rate Monitoring: Nomenclature, Interpretation, and General Management Principles - Intrapartum Fetal Heart rate Monitoring: Nomenclature, Interpretation, and General Management Principles - not available at ACOG's request
  4. AHRQ Maternal and Neonatal Outcomes of Elective Induction of Labor - Randomized controlled trials suggest that elective induction of labor at 41 weeks of gestation and beyond may be associated with a decrease in both the risk of cesarean delivery and of meconium-stained amniotic fluid.
  5. AHRQ Clinicain Guide - Elective Induction of Labor: Safety and Harms - This guide summarizes clinical evidence comparing the safety of elective induction of labor (induction at term without a medical indication) with expectant management (waiting for spontaneous labor in a term pregnancy).
  6. Childbirth Connection: Vaginal or Cesarean Birth? - A Systematic Review to Determine What is at Stake for Mothers and Babies
  7. Childbirth Connection: Why Does the Cesarean Rate Keep Going Up? - Why Does the Cesarean Rate Keep Going Up?
  8. Childbirth Connection: Vaginal Birth and  Cesarean Birth: How do the Risks Compare? - Vaginal Birth and  Cesarean Birth: How do the Risks Compare?
  9. Childbirth Connection: What Every Pregnant Woman Needs to Know About Cesarean Section - What Every Pregnant Woman Needs to Know About Cesarean Section
  10. Cochrane Review: Caesarean section for non-medical reasons at term - assessing from randomised trials, the effects on perinatal and maternal morbidity and mortality, and on maternal psychological morbidity, of planned caesarean delivery versus planned vaginal birth in women with no clear clinical indication for caesarean section.
  11. A Randomized Controlled Trial of Continuous Labor Support for Middle-Class Couples:Effect on Cesarean Delivery Rates - For middle-class women laboring with the support of their male partner, the continuous presence of a doula during labor significantly decreased the likelihood of cesarean delivery and reduced the need for epidural analgesia.
  12. Duration of Labor Induction in Nulliparous Women at Term: How Long Is Long Enough? - evaluating the relationship between duration of labor induction and successful vaginal delivery (VD) in nulliparous women at term.
  13. Labor Induction and the Risk of a Cesarean Delivery Among Nulliparous Women at Term - Labor induction is significantly associated with a cesarean delivery among nulliparous women at term for those with and without medical or obstetric complications. Reducing the use of elective labor induction may lead to decreased rates of cesarean delivery for a population.
  14. Contemporary Patterns of Spontaneous Labor With Normal Neonatal Outcomes - In a large, contemporary population, the rate of cervical dilation accelerated after 6 cm, and progress from 4 cm to 6 cm was far slower than previously described. Allowing labor to continue for a longer period before 6 cm of cervical dilation may reduce the rate of intrapartum and subsequent repeat cesarean deliveries
  15. Development of a large-scale obstetric quality-improvement program that focused on the nulliparous patient at term - The purpose of this study was to identify an appropriate population and a balanced set of maternal and neonatal measures to drive a hospital network obstetric quality improvement program.
  16. Guidelines for the management of postterm pregnancy - Paper produced under the auspices of the World Association of Perinatal Medicine for a consensus on issues in Perinatal practice
  17. Reconsideration of the Costs of Convenience - Quality, Operational, and Fiscal Strategies to Minimize Elective Labor Induction
  18. The Relationship Between Cesarean Section and Labor Induction - Labor inductions were associated with an increased likelihood of cesarean sections based on parity, age, race, number of prenatal visits, education, and hospital teaching status and ownership.
  19. Contemporary cesarean delivery practice in the United States - To decrease cesarean delivery rate in the United States, reducing primary cesarean delivery is the key. Increasing vaginal birth after previous cesarean rate is urgently needed. Cesarean section for dystocia should be avoided before the active phase is established, particularly in nulliparous women and in induced labor.
  20. Normal Progress of Induced Labor (ACOG) - The latent phase of labor is significantly longer in induced labor compared with spontaneous labor, although the active phase of labor (greater than 6 cm) is similar between the two groups. Arrest diagnoses before 6 cm in women undergoing induction should be made cautiously.


SIVB Sample Induction Policies/Order Sets from participants:

  1. Central Carolina Induction Order Set
  2. Central Carolina Policy - Scheduled CS and Induction
  3. CFVMC Clinical Guideline 1 - Labor Induction
  4. CFVMC Progress Note Labor Induction
  5. Forsyth OB Induction Orders
  6. Presbyterian Cervidil Orders
  7. Presbyterian Cytotec Orders
  8. Presbyterian Foley for Ripening Orders
  9. Presbyterian Low Dose Pitocin
  10. Presbyterian Pitocin Induction
  11. Rex Induction Guidelines
  12. Catawba Valley Medical Center Consent Form for Cytotec
  13. Onslow - Induction Order Set


SIVB Learning Session 2 Presentations

  1. Novant Perinatal Quality Improvement  (Albert)
  2. Catawba Valley Medical Center Perinatal Quality Improvement (Beckman)
  3. PQCNC SIVB Data Overview June 2011 Update - what is the data telling us so far?
  4. Pregnancy Home A Partnership Between DMA,CCNC, Local Health Departments, DPH, and NC Obstetricians (Gray)
  5. Is Cesarean Section Rate a Reasonable Quality Measure? (Chescheir)
  6. Ethics and Guideline Development: Implications for the Supporting Intended Vaginal Birth initiative (Lyerly)