To improve maternal outcomes, get mom’s care goals on the board (2024)

About 90% of patients giving birth to the 5,600 babies delivered annually at Saint Peter’s University Hospital in New Brunswick, New Jersey, feel they have a say in the decision-making and fully understand the pros and cons of treatment options in the experience.

That is no accident. Rather, it is a result of the hospital’s participation in a structured process called TeamBirth, which is designed around best practices in communications, obstetric teamwork and clinical care.

The hospital—part of the Saint Peter’s Healthcare System—implemented TeamBirth last September and, by March, saw a huge rise in communications-related patient-satisfaction scores as measured by the Mothers Autonomy in Decision Making (MADM) scale.

Last year, 57% of patients said they felt involved in the decision-making involving their birthing experience. By March, that rose to 88%.

Prior to TeamBirth implementation, 43% said they felt the pros and cons of those options were fully explained. After implementation, that surged to 91%.

Statistics such as these show the structured-communication process is worth the investment.

“A big piece is showing the data so that people are willing to stay invested—and then it slowly will become second nature,” said William Lowe, III, MD, vice chair of Saint Peter’s ob-gyn department and medical director for the Mary V. O’Shea Birth Center at Saint Peter’s University Hospital.

“That's pretty motivational data for doing it,” Dr. Lowe added. “It's really just structured communication, and no matter what generation that you come from, communication has always been a vital piece of medicine.”

Saint Peter’s Healthcare System is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.

Improving maternal health outcomes has become a priority in New Jersey as pregnancy-related deaths have risen 17.2%, going from 12.8 per 100,000 deaths from 2011—2013, to 15 per 100,000 from 2014—2016, according to the state’s health department. The data also shows that the state’s Black and Hispanic women are seven times more likely to die in childbirth than white women: 46.9 per 100,000 live births in 2014—2016, compared with 6.5 for white women.

Developed by Ariadne Labs in Boston, “TeamBirth is an evidence-based communication model focused on shared decision-making and the goal is for the mother to have a voice and to feel that she's being heard during her birth experience,” said Pam Harmon, DNP, MSN, nursing director of women and children's services at St. Peter's University Hospital and administrative director of the birth center.

“It is all about improving maternal outcomes, and the No. 1 reason responsible for majority of preventable medical injuries and maternal health is centered around communication,” Harmon said.

Harmon added that TeamBirth also improves health equity among Black and Hispanic patients who often report that they weren’t listened to during their birthing experience.

She cited the 2019 “Giving Voice to Mothers” survey in which World Health Organization researchers found that 17.3% of patients reported mistreatment while receiving maternity care in the U.S. This included loss of autonomy; being shouted at, scolded or threatened; and being ignored, refused or receiving no response to requests for help.

More recently, an August 2023 Centers for Disease Control and Prevention study found that 20.4% of patients reported at least one type of mistreatment during maternity care.

As part of its advocacy to improve maternal health, the AMA has outlined concrete actions that should be taken to reduce and prevent rising rates of maternal mortality and serious or near-fatal maternal morbidity in the U.S.

With TeamBirth, patients meet in huddles or pauses with members of their care teams, including physicians, nurses, certified nurse midwives and others to discuss goals and care plans.

The pertinent details are written on a dry-erase board in clear view of the patient or anyone else who enters the room.

Items on the board may cover:

• Promoting the roles of the laboring patient.
• Patient preferences, symptoms and experiences.
• Clinical data that informs care plans.
• Maternal, fetal and labor statuses.
• Shared expectations for the next planned evaluation.

“At the minimum, we'll do it upon admission, but we bring the entire team together—whoever is directly involved with that care—and everyone's in the room,” Harmon said. “Then you can start to address what the care plan is.”

This approach eliminates hierarchy in communication, Harmon explained. Often the patient will have a concern and tell the nurse, who then has to call the physician or nurse midwife, and the nurse then relays that information back to the patient.

“This way, everyone hears the concern at the same time,” she said. “If the mother or the support person still has additional questions, they're able to voice them right then and there and everyone knows her desires and what her concerns are for the birth experience that she wants to have.”

At some point, the dry-erase board may be replaced with a digital screen, Dr. Lowe said. But, for now at least, the low-tech method has been working.

“The whiteboard is a great focal point,” he said. “What’s important is on the board,” which also includes food preference, status of pain relief and labor progression.

The board “gives you an outline of taking care of the patient, everybody's name and everybody's role,” Dr. Lowe explained. “We're not really changing what we're doing—we're just structuring it.”

Learn more with the AMA about seven keys to improving maternal health now.