CASE The TeamBirth experience: Making a difference
“At a community hospital in Washington where we had implemented TeamBirth (a labor and delivery shared decision making model), a patient, her partner, a labor and delivery nurse, and myself (an ObGyn) were making a plan for the patient’s induction of labor admission. I asked the patient, a 29-year-old (G2P1001), how we could improve her care in relation to her first birth. Her answer was simple: I want to be treated with respect. Her partner went on to describe their past experience in which the provider was inappropriately texting while in between the patient’s knees during delivery. Our team had the opportunity to undo some of the trauma from her first birth. That’s what I like about TeamBirth. It gives every patient the opportunity, regardless of their background, to define safety and participate in their care experience.”
–Angela Chien, MD, Obstetrician and Quality Improvement leader, Washington
Unfortunately, disrespect and mistreatment are far from an anomaly in the obstetrics setting. In a systematic review of respectful maternity care, the World Health Organization delineated 7 dimensions of maternal mistreatment: physical abuse, sexual abuse, verbal abuse, stigma and discrimination, failure to meet professional standards of care, poor rapport between women and providers, and poor conditions and constraints presented by the health system.1 In 2019, the Giving Voice to Mothers study showed that 17% of birthing people in the United States reported experiencing 1 or more types of maternal mistreatment.2 Rates of mistreatment were disproportionately greater in populations of color, hospital-based births, and among those with social, economic, or health challenges.2 It is well known that Black and African American and American Indian and Alaska Native populations experience the rare events of severe maternal morbidity and mortality more frequently than their White counterparts; the disproportionate burden of mistreatment is lesser known and far more common.
Overlooking the longitudinal harm of a negative birth experience has cascading impact. While an empowering perinatal experience can foster preventive screening and management of chronic disease, a poor experience conversely can seed mistrust at an individual, generational, and community level.
The patient quality enterprise is beginning to shift attention toward maternal experience with the development of PREMs (patient-reported experience measures), PROMs (patient-reported outcome measures), and novel validated scales that assess autonomy and trust.3 Development of a maternal Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey on childbirth is forthcoming.4 Of course, continuing to prioritize physical safety through initiatives on blood pressure monitoring and severe maternal morbidity and mortality remains paramount. Yet emotional and psychological safety also must be recognized as essential pillars of patient safety. Transgressions related to autonomy and dignity, as well as racism, sexism, classicism, and ableism, should be treated as “adverse and never events.”5
How the TeamBirth model works
Shared decision making (SDM) is cited in medical pedagogy as the solution to respectfullyrecognizing social context, integrating subjective experience, and honoring patient autonomy.6 The onus has always been on individual clinicians to exercise SDM. A new practice model, TeamBirth, embeds SDM into the culture and workflow. It offers a behavioral framework to mitigate implicit bias and operationalizes SDM tools, such that every patient is an empowered participant in their care.
TeamBirth was created through Ariadne Labs’ Delivery Decisions Initiative, a research and social impact program that designs, tests, and scales transformative, systems-level solutions that promote quality, equity, and dignity in childbirth. By the end of 2023, TeamBirth will be implemented in more than 100 hospitals across the United States, cumulatively touching over 200,000 lives. (For more information on the TeamBirth model, view the “Why TeamBirth” video at: https://www.youtube.com/watch?v=EoVrSaGk7gc.)
The tenets of TeamBirth are enacted through a patient-facing, shared whiteboard or dry-erase planning board in the labor room (FIGURE 1). Research has demonstrated how dry-erase boards in clinical settings can support safety and dignity in care, especially to improve patient-provider communication, teamwork, and patient satisfaction.7,8 The planning board is initially filled out by a clinical team member and is updated during team “huddles” throughout labor.
ILLUSTRATION: KIMBERLY MARTINS FOR OBG MANAGEMENT
Huddles are care plan discussions with the full care team (the patient, nurse, doula and/or other support person(s), delivering provider, and interpreter or social worker as needed). At a minimum, huddles occur on admission, with changes to the clinical course and care plan, and at the request of any team member. Huddles can transpire through in-person, virtual, or phone communication.9 The concept builds on interdisciplinary and patient-centered rounding and establishes a communication system that is suited to the dynamic environment and amplified patient autonomy unique to labor and delivery. Dr. Bob Barbieri, a steadfast leader and champion of TeamBirth implementation at Brigham and Women’s Hospital in Boston (and the Editor in Chief of OBG Management), recognized the importance of the dry-erase board in “memorializing the decisions made.”
Continue to: Patient response to TeamBirth is positive...