Complications of childbirth and delivery are any pathological deviations of the birth process from the norm, the consequence of which is a violation of the work of the body of the mother or child. The instances of such deviations include, for example, premature childbirth, violated labor activity, postpartum hemorrhage, obstetric injuries, and others. Modern medicine has specific tools and methods to determine the possible causes of complications long before the onset of childbirth and prevent or manage them to provide the best outcomes for mother and child. Thus, it is a crucial quality improvement issue, as it affects the most vulnerable populations and has lasting consequences for patients’ health.
|Metric Title||Metric Number||Metric Description||Metric Type||Endorsement Status|
|PC-02 Cesarean Birth||0471||A measure designed to evaluate how many women nationally had a cesarean delivery. According to The Joint Commission (2020b), this measure “assesses the rate of nulliparous women with a term, singleton baby in a vertex position delivered by cesarean birth” (para. 1). It is an important metric as it provides insight on the changes in the rates of cesarean birth: reduction of the numbers of this kind of delivery will result in better patient outcomes.||Outcome||Endorsed|
|PC-01 Elective Delivery||0469||With this measure, the rates of women choosing different types of delivery are evaluated. The Joint Commission (2020a) states that “it assesses patients with elective vaginal deliveries or elective cesarean births at >= 37 and < 39 weeks of gestation completed” (para. 1). The numbers of non-medically indicated elective deliveries such as cesarean birth need to decrease to ensure low labor morbidity for mothers and children.||Process||Endorsed|
|Pregnant women that had HIV testing||0606||This measure is aimed at encouraging HIV testing in pregnant women. Ingenix (2009) evaluated how many pregnant women had a HIV test during the 280 days before their delivery. Such an assessment is necessary to ensure women and unborn children’s health and prepare the obstetrics personnel for potential risks associated with delivery in HIV-positive pregnancies.||Structure||Endorsement removed|
Evidence-Based Practice Improvement to Address the Issue
Bleeding during pregnancy and childbirth remains one of the leading causes of maternal death in the world. Pregnancy-related blood loss can occur in women in all trimesters of pregnancy, in the first and postpartum periods of childbirth, as well as in the early and late postpartum periods. Often, postpartum hemorrhage (PPH) is caused by iatrogenic factors associated with “obstetric aggression” during childbirth. To these factors belong: unmotivated induction and stimulation of labor; the use of the Christeller method, which promotes trauma; amniotomy with an “immature” cervix, which increases the frequency of cesarean section. Many of these cases are often associated with a lack of specific education among the nurses.
Thus, the implementation of tailored and well-designed educational practices is necessary to address the issue of labor and postpartum care quality. Anca et al. (2020) claim that “incorporation of a standard Hemorrhage Risk Assessment (HRA) has shown improvements in identification of all women at risk for complications and a reduction in the incidence of PPH” (p. 1). The educational interventions must support policies and guidelines to create a safe environment and reduce risk factors. As Anca et al. (2020) further supply, “the results of that educational intervention show 100% compliance for HRA scores communication during perioperative huddles, while activation of massive transfusion protocols was decreased by 20%” (p. 1). This research directly shows how important nursing intervention is in preventing postpartum hemorrhage and decreasing maternal mortality risks. It also emphasizes how prevention strategies explained in the process of education should stimulate engagement in technical aspects to eliminate potential hemorrhage hazards. Finally, the last point of nurses’ education should elaborate on raising awareness among patients and communities on the risk factors and prevention measures of postpartum hemorrhage.
Anca, R., Mahoney, M., & Lucarini, E. (2020). Nurse-Driven initiative to increase awareness during perioperative interprofessional huddles of women at risk for postpartum hemorrhage. Journal of Obstetric, Gynecologic & Neonatal Nursing, 49(6).
Ingenix. (2009). Pregnant women that had HIV testing. National Quality Forum. Web.
The Joint Commission. (2020a). PC-01 Elective Delivery. National Quality Forum. Web.
The Joint Commission. (2020b). PC-02 Cesarean Birth. National Quality Forum. Web.