Documents

READINESS

BirthTOOLS.org - a website offering a toolkit of evidence based practices to support physiologic birth.  The toolkit was created by the American College of Nurse Midwives and Childbirth Connection, along with representatives from Association of Women’s Health, obstetric and neonatal nurses, National Association of Certified Professional Midwives and Lamaze International.

Childbirth Connection, Hormonal Physiology of Childbearing:  Fact Sheets on Core Topics  - this set of fact sheets from Childbirth Connection outlines hormonal changes through the process of labor and delivery, highlighting how to support hormonal changes during non-physiologic birth.

Maternal preference for cesarean delivery - do women get what they want?  - this article discusses the association between maternal preference for cesarean delivery and the actual mode of delivery experienced.  Women who preferred a cesarean delivery were more likely to ultimately deliver via cesarean section.  Education to address concerns regarding vaginal delivery are important in reducing primary and overall rates of cesarean section.

Low-risk, primary cesarean births in Medicaid:  National Association of Medicaid Directors/Association of Maternal and Child Health Programs Issue Brief 2015  - this brief outlines several strategies for Medicaid payment approaches with providers to decrease the primary and overall cesarean delivery rate.  Realizing that multiple approaches will be required to successfully decrease cesarean deliveries, partnerships between state agencies are also explored.

Consequences of a primary elective cesarean delivery across the reproductive life  - this article measured maternal morbidity associated with elective primary cesarean delivery versus a trial of labor.  Measured complications of delivery included transfusion, operative injury, deep venous thrombosis, hysterectomy and death. 

Safe reduction of the primary cesarean delivery  - this consensus statement by the American College of Obstetricians and Gynecologists discusses the indications for cesarean delivery, the risks of adverse maternal and neonatal outcomes by mode of delivery, the cesarean delivery rates across the United States, and offers guidance on clinical management in each stage of labor to reduce cesarean deliveries.  The initial statement was published in 2014 and reaffirmed in 2016. 

 

RECOGNITION

BirthTOOLS.org - a website offering a toolkit of evidence based practices to support physiologic birth.  The toolkit was created by the American College of Nurse Midwives and Childbirth Connection, along with representatives from Association of Women’s Health, obstetric and neonatal nurses, National Association of Certified Professional Midwives and Lamaze International.

AWHONN Women’s Health and Perinatal Nursing Care Quality Refined Draft Measures Specifications  - the draft, released in 2014, defines nursing care quality measures defined by AWHONN to improve care provided to women and children.

Primary Cesarean Delivery in the United States  - this article describes a large retrospective cohort study examining indications for primary cesarean section and highlights opportunities to lower the primary cesarean rate and thus the total cesarean rate.

CRICO Clinical Guidelines for Obstetrical Services - Guideline 15:  Assessment and Monitoring in Labor and Delivery  - this document provides guidelines for the clinical provider to include admission to labor and delivery, initial evaluation of the patient and continues through first and second stages of labor and delivery of the infant.  Also included are guidelines for patient education during and after labor and delivery.

Cesarean deliveries, outcomes and opportunities for change in California:  Toward a public agenda for maternity care safety and quality  - this white paper provides an in-depth summary of the practices behind the rising cesarean delivery rates in California.  The summary provides recommendations for decreasing cesarean delivery rates to include quality improvement, payment reform and education that can be implemented effectively in any state.

Preventing the First Cesarean Delivery:  Summary of a Joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal- Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop - this article summarizes the content and discussion provided at a workshop supported by the National Institute of Child Health and Human Development, the Society for Maternal-Fetal Medicine, and the American College of Obstetricians and Gynecologists on preventing primary cesarean delivery.  The discussion includes indications for delivery, labor management practices, diagnosis of arrest disorders, operative vaginal delivery, evaluation of fetal status before and during labor, and non-medical factors contributing to primary cesarean delivery.  Algorithms for the management of induction of labor, assessment of intrapartum fetal heart rate monitoring and spontaneous labor are included. 

 

RESPONSE

BirthTOOLS.org - a website offering a toolkit of evidence based practices to support physiologic birth.  The toolkit was created by the American College of Nurse Midwives and Childbirth Connection, along with representatives from Association of Women’s Health, obstetric and neonatal nurses, National Association of Certified Professional Midwives and Lamaze International.

AWHONN Women’s Health and Perinatal Nursing Care Quality Refined Draft Measures Specifications  - the draft, released in 2014, defines nursing care quality measures defined by AWHONN to improve care provided to women and children.

Primary Cesarean Delivery in the United States  - this article describes a large retrospective cohort study examining indications for primary cesarean section and highlights opportunities to lower the primary cesarean rate and thus the total cesarean rate.

CRICO Clinical Guidelines for Obstetrical Services - Guideline 15:  Assessment and Monitoring in Labor and Delivery - this document provides guidelines for the clinical provider to include admission to labor and delivery, initial evaluation of the patient and continues through first and second stages of labor and delivery of the infant.  Also included are guidelines for patient education during and after labor and delivery.

Labor and delivery teamwork leads to fewer cesareans  - this article describes the collaborative practice experience between midwifery, laborists and obstetricians at a hospital in California at the Society for Maternal-Fetal Medicine 2015 Annual Pregnancy Meeting.  This model was able to demonstrate a decline in the rate of cesarean delivery for nulliparous women and an increase in the rate of vaginal birth after cesarean delivery.

Cesarean deliveries, outcomes and opportunities for change in California:  Toward a public agenda for maternity care safety and quality  - this white paper provides an in-depth summary of the practices behind the rising cesarean delivery rates in California.  The summary provides recommendations for decreasing cesarean delivery rates to include quality improvement, payment reform and education that can be implemented effectively in any state.

Safe reduction of the primary cesarean delivery  - this consensus statement by the American College of Obstetricians and Gynecologists discusses the indications for cesarean delivery, the risks of adverse maternal and neonatal outcomes by mode of delivery, the cesarean delivery rates across the United States, and offers guidance on clinical management in each stage of labor to reduce cesarean deliveries.  The initial statement was published in 2014 and reaffirmed in 2016. 

Preventing the First Cesarean Delivery:  Summary of a Joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal- Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop - this article summarizes the content and discussion provided at a workshop supported by the National Institute of Child Health and Human Development, the Society for Maternal-Fetal Medicine, and the American College of Obstetricians and Gynecologists on preventing primary cesarean delivery.  The discussion includes indications for delivery, labor management practices, diagnosis of arrest disorders, operative vaginal delivery, evaluation of fetal status before and during labor, and non-medical factors contributing to primary cesarean delivery.  Algorithms for the management of induction of labor, assessment of intrapartum fetal heart rate monitoring and spontaneous labor are included.

 

REPORTING

Labor and delivery teamwork leads to fewer cesareans  - this article describes the collaborative practice experience between midwifery, laborists and obstetricians at a hospital in California at the Society for Maternal-Fetal Medicine 2015 Annual Pregnancy Meeting.  This model was able to demonstrate a decline in the rate of cesarean delivery for nulliparous women and an increase in the rate of vaginal birth after cesarean delivery.

Consequences of a primary elective cesarean delivery across the reproductive life  - this article measured maternal morbidity associated with elective primary cesarean delivery versus a trial of labor.  Measured complications of delivery included transfusion, operative injury, deep venous thrombosis, hysterectomy and death. 

Ready to get started and submit your team roster? Click here

PQCNC is proud to announce that registration is now open for the statewide Newborn Hypoglycemia Prevention and Care (NHPC) initiative. 

The NHPC Expert Team will create a concise action plan which will guide hospital NHPC teams in this work as well as measures which will guide teams and the collaborative in this work.

The NHPC collaborative will be facilitated by the PQCNC core team working with your hospital teams and, as with all PQCNC initiatives, will include informative webinars and quarterly face to face learning sessions as well as weekly email updates to keep all apprised of new reports on the topic, opportunities to excel developed by teams, and critical developments in the collaborative.

The PQCNC NHPC initiative offers your facility a unique, structured opportunity to address the challenges of hypoglycemia. This project will be approved for Maintenance of Certification for your physician providers. Our face to face learning sessions will offer CEU and CME credit. 

This all is at NO cost to your hospital.

Want to join us on this incredible journey? - use the links above.

Need more information? - click here  

Questions? - click here 

Tuesday, July 17th at 1200 - register here

Approve data collection and discuss pre-work

Join the Newborn Hypoglycemia Prevention and Care (NHPC) Expert Team - click here

 

Expert Team Resources

Dextrose gel for neonatal hypoglycaemia (the Sugar Babies Study): a randomised, double-blind, placebo-controlled trial - This seminal article has shaped the management of neonatal hypoglycemia. This study out of New Zealand recommends treatment with dextrose gel be considered the first-line treatment to manage hypoglycemia in late preterm and term babies in the first 48 hours after birth.  The authors concluded dextrose gel is inexpensive, simple to administer and can successfully reverse newborn hypoglycemia. 

Neonatal hypoglycemia, defined as a plasma glucose level of less than 30 mg/dL (1.65 mmol/L) in the first 24 hours of life and less than 45 mg/dL (2.5 mmol/L) thereafter, is the most common metabolic problem in newborns. Major long-term sequelae include neurologic damage resulting in mental retardation, recurrent seizure activity, developmental delay, and personality disorders. Some evidence suggests that severe hypoglycemia may impair cardiovascular function.

Outcome at two years after dextrose gel treatment for neonatal hypoglycemia; Follow up of a randomized trial -  This follow up study to the Sugar Babies paper confirms that treatment with dextrose gel is not associated with additional risks or benefits at two years of age.  The authors claim that clinicians and families can be reassured that the advantages of treatment with dextrose gel soon after birth are not counterbalanced by increased risk of poor neurodevelopmental outcomes at two years’ corrected age. 

Clinical Report—Postnatal Glucose Homeostasis in Late-Preterm and Term Infants - Published in Pediatrics, this report provides a practical guide and algorithm for the screening and subsequent management of neonatal hypoglycemia. Highlighting the fact that no rigorous scientific definition has been reached, this influential article from 2011, continues to be endorsed today as the guidelines to manage neonatal hypoglycemia by the American Academy of Pediatrics.

Early skin-to-skin contact for mothers and their healthy newborn infants. - This extensive Cochrane review discusses the general consensus that “minimally, skin to skin contact should continue until the end of the first successful breastfeeding in order to show an effect and to enhance early infant self-regulation.”  Cited in this article as one of the common reasons for separation is hypoglycemia.  The review highlights evidence for a clinically meaningful increase in blood glucose in infants who received skin to skin contact and goes on to say that even if practiced for a “short time at birth [skin to skin contact] should have measurable breastfeeding effects one to four months’ post birth.”

New approaches to management of neonatal hypoglycemia. - This very informative article focuses on the role of buccal dextrose gel in the management of asymptomatic neonatal hypoglycemia and encourages the use of dextrose gel as part of a treatment protocol.  Additionally, the authors support the abandonment of the intravenous dextrose bolus for the treatment of asymptomatic, hypoglycemic late preterm, LGA, SGA/IUGR, and IDM newborns.

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