Home / Quality Initiatives / Safely Averting NTSV Cesarean Births

Safely Averting NTSV Cesarean Births

Mother and newborn baby

Background

OBI is working with 70+ hospital teams in Michigan to support physiologic birth, offer more equitable, respectful care, and prevent unnecessary cesarean births.

The Problem

The national Nulliparous Term Singleton Vertex (NTSV) cesarean rate is high and varies substantially across hospitals. The NTSV cesarean rate in Michigan is significantly higher than the national average.

23.6%

Healthy People 2030 NTSV Cesarean rate goal

s

28%

Michigan’s average NTSV cesarean rate

11-41%

Variation in NTSV cesarean rate in Michigan hospitals

Aim

By December 2025, 50% of participating hospitals will achieve their NTSV cesarean goal.

Goals

  • Increase the percent of NTSV cesarean births for dystocia that meet ACOG/SMFM criteria
  • Increase the percent of NTSV cesarean births for abnormal/indeterminate fetal heart rate tracing that have documentation of management with an algorithm
  • 70% of participating hospitals have a process for NTSV cesarean case review
  • Reduce the percent of participating hospitals with an NTSV cesarean rate over 30%
  • Increase the number of participating hospitals with an NTSV cesarean rate below the HP2030 target of 23.6%

Implementation Resources

Initiative Background

Clinical Guidance for Labor Dystocia

Clinical Guidance for Management of Category II Fetal Heart Tracings (FHTs)

C-Suite Letter

A high-level overview of OBI’s initiative to safely avert cesarean births in the nulliparous, term, singleton, vertex (NTSV) population and the associated 2024 Pay for Performance Scorecard metrics. Share with with your local C-Suite to improve leadership awareness & buy-in, and to inform decision-making, resource allocation, and quality improvement strategies.

QI Planning & Implementation Tools

Safely Averting NTSV Cesarean Births QI Blueprint

Safely Averting NTSV Cesarean Births QI Blueprint: A guide developed to help your multidisciplinary champion team create an actionable quality improvement (QI) plan to promote vaginal birth and safely lower the NTSV cesarean rate at your hospital.

OBI 2023 Site Visit Summary Report: Barriers, Facilitators, & Strategies for Safely Lowering the NTSV Cesarean Rate

  • OBI 2023 Site Visit Summary Report: Barriers, Facilitators, & Strategies for Safely Lowering the NTSV Cesarean Rate: This report is designed for individuals leading quality improvement (QI) efforts to safely lower the NTSV cesarean rate. The goal of this report is to help QI champions measure barriers and facilitators to safely lower the NTSV cesarean rate and link barriers/facilitators to QI strategies that will promote successful clinical practice change. We invite you to carve out time to read and reflect on this report and discuss key findings with your OBI Champion Team.

EHR Templates

OBI Category II Fetal Heart Rate Tracing Management Algorithm

OBI Category II Fetal Heart Rate Tracing Management Algorithm. May 2024.

Clinician Engagement

OBI Criteria Badge Buddy

A two-sided, 4”x 3” inch badge buddy that can be used as a fast reference reminder for Labor Dystocia compliance criteria and Category II FHR monitoring interventions.

Consider printing these for all members of your clinical team!

Training Slide Deck Template

Coming soon!

Moving our Mamas (MOMs) Labor Support Training

To host a hands-on labor support training class for your maternity care staff, please contact Patricia Klassa MSN, RN, CNS-C, IBCLC ([email protected]) and Cheryl (Larry-Osman) Bellamy DNP, BS, APRN, CNM, CNS-C, C-EFM ([email protected]).

Patient Engagement

Labor Support Guide

Use this guide to identify, discuss, and select options for labor support with your team.

Coping with Labor Algorithm

University of Utah College of Nursing and University of Utah Hospital & Clinics Coping with Labor Algorithm.

QI Evaluation

Sample Performance Reports

NTSV Case Review Materials

Case Review materials have moved!

Visit the P4P Page