TeamBirth: Giving women a voice during labor and delivery
I spent much of my nursing career in pediatrics, and one of my favorite experiences during my years working in the hospitals was in the maternity department.
In those days, some 20-plus years ago, discussions between nursing staff, obstetricians, and other members of the healthcare team about the patient’s progress with labor and delivery were either held at the nurses’ station or outside the mother’s room.
Once the baby was born, mom would get to touch her baby’s hand or hug them briefly before the nurse whisked them off to the nursery. There, we would bathe the baby, check their vital signs and keep a watchful eye on their adjustment to the world outside the womb.
Fast forward to April 11, 2023, when I had the opportunity to be in The Family Birthplace at Cape Cod Hospital to learn about and participate in the “go live” day for a new program known as TeamBirth.
TeamBirth aims to promote equity in childbirth by making the patient an active participant in her healthcare team discussions and decisions throughout labor and delivery.
Historically, discussions by members of the healthcare team did not actively include the patient’s participation or input. That has now changed with discussions known as “huddles,” occurring at the patient’s bedside, with set times for updates throughout the patient’s labor and delivery.
“As doctors and nurses, we huddle all the time to discuss our patients and their care,” said Lindsay LaCorte, DO, MPH, FACOOG, a Cape Cod Hospital obstetrician. “There is usually a nurse, obstetrician, and midwife huddling throughout the day, but it has always been done in the hallway. Now it’s bringing those discussions into the room with the patient. So, what TeamBirth is doing is making us think about it and streamline it to include our patients in an obvious way while continuing to give the same care we have always provided.”
Another Milestone
TeamBirth is another milestone in improving experiences for women delivering at the hospital, said Jennifer Lacasse, MSN, RNC, FNP-C, C-EFM, director of Women and Children Services at Cape Cod Hospital.
“The department obtained the Baby-Friendly designation in November 2022, which promotes family-centered care and informed decision-making,” she said. “Our babies transition from the womb to outside life by being placed skin-to-skin with their mother immediately after birth, which helps regulate temperature, promotes bonding, reduces stress, enhances immune function, and facilitates breastfeeding. Infants stay in the same room as their parents after birth. Rooming-in promotes family-centered care involving both parents and allowing them to participate in the baby’s care and daily routine.”
“In our prenatal education classes, we share with our clients that we are baby-friendly, so they have an expectation of how things are going to go when they come to maternity,” said Alissa Krieger-DeWitt, RN, Cape Cod Hospital childbirth educator. “The Baby-Friendly designation is the infrastructure of our unit, and the TeamBirth is our communication. So, it’s how we hold up our infrastructure. The women expect to be a part of the collaborative process when they are admitted, which is seamless and complete. Baby-Friendly is our framework, and TeamBirth is how we make it seamless between our families and our staff.”
The Whiteboard
Prior to the TeamBirth concept, a midwife would go into the patient’s room, have a conversation with her, and then come out and have a conversation with the primary nurse, a clinical leader and the obstetrician who was covering the floor, according to Lacasse.
“None of that happens now. We have conversations in the patient’s room, she hears everything we all have to say, and she gives her input into the plan. It’s simple,” she said.
The patient’s plan, time of medications, steps that will be taken during her labor, and any changes are all written on a whiteboard in her room so she will know what to expect. The huddles are held throughout her labor as needed.
TeamBirth is a pilot program of Ariadne Labs in partnership with Brigham and Women’s Hospital and Harvard T.H. School of Public Health. It is designed to give every member of the team, including obstetricians, midwives, the patient’s primary care nurse, lactation consultant, and the patient, an opportunity to contribute information, have structured communication, and develop a plan. This also helps the patient have a clear understanding of what is happening, the plan and goals for her care, and gives her the information she needs to make informed decisions about her care, said Lacasse.
Cape Cod Hospital was recruited to participate in an 18-month collaboration along with nine other hospitals across the region to address disparities in childbirth experiences and to reduce inequities in the birth experience and outcomes, she said.
“It is a perfect fit for our process improvement project,” said Lacasse. “We practice evidence-based medicine, we have a fabulous team, we have a lot of services, and it’s time for everyone to know the great work we do here.”
