Preventable birth injuries are rare. At the University of Minnesota Medical Center (UMMC), they happen just 0.3 percent of the time, or to about four babies out of 2,700 deliveries each year.
“But even if you only have 0.3 percent, that’s still four babies a year. And that’s somebody’s baby,” says Becky Gams, R.N., M.S., C.N.P., clinical nurse leader and site coordinator for the new Zero Birth Injury safety campaign at the University’s hospital.
“There’s an economic cost, a liability cost, [and] there’s a very personal cost—for everybody involved,” says Philip Rauk, M.D., medical director of the hospital’s Birthplace and also a UMMC site coordinator for the initiative.
The multidisciplinary Zero Birth Injury effort aims to render preventable birth injuries obsolete. UMMC is one of six hospitals owned by Fairview Health Services in the Twin Cities metro area that is reevaluating best practices focused on three aspects of delivery to enhance newborn safety: induction, augmentation, and vacuum delivery.
In recent decades, Rauk says, birthing decisions across the country were being made based on concerns other than the health of the mother and baby. Many inductions, for example, were done primarily for the mother’s or the physician’s convenience.
Now Fairview’s policy is not to perform elective inductions before 39 weeks, thereby reducing the chances of a lengthy labor and Caesarean section. “And we improved on that by also saying [the mother] should at least be ready to go into labor,” Rauk says.
The way inductions are done also is changing based on new science. For instance, giving patients higher doses of pitocin, a medication intended to hasten contractions, has become increasingly common over the past couple of decades. But higher does of pitocin have been associated with contractions that were too close together, which in turn were associated with birth injuries. Newer science suggests that contractions that are too close together affect the baby’s oxygen levels sooner than previously understood, and now health-care providers pay closer attention to contraction frequency.
So far compliance with the new safety standards is high at most participating hospitals, but it’s too early to discern whether or how that’s affecting outcomes, Gams says. She and Rauk expect to see definitive changes in outcomes by early 2010.
Ultimately, most health-care professionals and patients appreciate the need to put science and safety ahead of expedience, Rauk says.
“We’re taking evidence-based medicine out of the journal article and bringing it to the bedside,” he says.