Why our perinatal outcomes keep getting better

From the time a woman finds out she’s pregnant, she often starts planning what her birth experience will be like. Whether the birth plan includes an epidural, a doula, a waterbirth or even a vaginal birth after a previous cesarean section (VBAC), Asante is determined to provide the experience she wants in the safest way possible.

Delivering more than 2,000 babies per year, Asante has three birth centers, each unique in the birth experience they provide but unwavering in their dedication to quality care.

The Asante Perinatal Safety Committee is a systemwide, multidisciplinary team with a goal of improving maternal and newborn outcomes. Key outcomes include:

• Primary cesarean section rate
• Birth trauma (injury to the newborn)
• Obstetric trauma (injury to the mom)
• Elective inductions occurring prior to 39 weeks gestation
• Unattended deliveries (deliveries without provider present)
• Divert hours

Planning for delivery

Each of Asante’s birth centers has differing levels of care and services. Providers use risk stratification for planned deliveries to guide their patients to select the appropriate facility to meet their medical needs and desired birth plan; patient safety is always the priority in determining where to deliver.

Childbirth can be low-risk to high-risk, and risk is determined by many factors that may cause complications. Some deliveries are high-risk due to complications with the fetus, health conditions of the mom or the type of delivery the woman is seeking.

ARRMC is designated as Asante’s high-risk birth center, so resources to support high-risk deliveries have been concentrated in this location. These include onsite anesthesia, onsite OB providers and the Neonatal Intensive Care Unit. For deliveries that are not anticipated to be high-risk, ATRMC and AACH provide comprehensive obstetrical services with teams dedicated to providing safe, patient-centered care.

Quality improvement from a systems perspective

In 2019, ARRMC became the first Oregon hospital to have a designated obstetrical emergency department (OB ED); an OB hospitalist program was introduced in tandem. The OB ED and OB hospitalist services are strategic initiatives to improve obstetrical patient safety at Asante’s high-risk birth center. Women who present to ARRMC with an obstetrical concern or emergency are seen by an OB physician within minutes of their arrival.

Unattended deliveries, or deliveries without a provider present, are safety concerns in obstetrical care. The OB ED and OB hospitalist program have been instrumental in decreasing these safety events.

In 2017, ARRMC had 34 unattended deliveries. Through case evaluation and process improvement, we saw a decrease to 18 unattended deliveries in 2018. With the implementation of the OB ED and OB hospitalist program, unattended deliveries continued to drop year over year. While certain unattended deliveries may be unavoidable, there is now a safe and reliable system limiting these events.

We are proud of the range of obstetrical services we provide at Asante. As we continue to deliver the birth experiences our community seeks, we do so with patient safety leading every decision.