Maternal morbidity during childbirth hospitalization in California

Lyndon, Audrey; Lee, Henry; Gilbert, William M.; Gould, Jeffrey B.; Lee, Kathryn A.

doi:10.3109/14767058.2012.710280

Cited by 70 publications

(50 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Caesarean birth also increases the risk for severe maternal morbidity,34 another ICHOM outcome 14. Delayed care and absence of 1-to-1 midwifery care in labour are considered ‘midwifery red flag events’ in the UK 35.…”

Section: Discussionmentioning

confidence: 99%

Thematic analysis of US stakeholder views on the influence of labour nurses’ care on birth outcomes

2017

Self Cite

View full text Add to dashboard Cite

Background Childbirth is a leading reason for hospital admission in the USA, and most labour care is provided by registered nurses under physician or midwife supervision in a nurse-managed care model. Yet, there are no validated nurse-sensitive quality measures for maternity care. We aimed to engage primary stakeholders of maternity care in identifying the aspects of nursing care during labour and birth they believe influence birth outcomes, and how these aspects of care might be measured. Methods This qualitative study used 15 focus groups to explore perceptions of 73 nurses, 23 new mothers and 9 physicians regarding important aspects of care. Transcripts were analysed thematically. Participants in the final six focus groups were also asked whether or not they thought each of five existing perinatal quality measures were nurse-sensitive. Results Nurses, new mothers and physicians identified nurses' support of and advocacy for women as important to birth outcomes. Support and advocacy actions included keeping women and their family members informed, being present with women, setting the emotional tone, knowing and advocating for women's wishes and avoiding caesarean birth. Mothers and nurses took technical aspects of care for granted, whereas physicians discussed this more explicitly, noting that nurses were their 'eyes and ears' during labour. Participants endorsed caesarean rates and breastfeeding rates as likely to be nurse-sensitive.Conclusions Stakeholder values support inclusion of maternity nursing care quality measures related to emotional support and providing information in addition to physical support and clinical aspects of care. Care models that ensure labour nurses have sufficient time and resources to engage in the supportive relationships that women value might contribute to better health outcomes and improved patient experience.

show abstract

Section: Discussionmentioning

confidence: 99%

Thematic analysis of US stakeholder views on the influence of labour nurses’ care on birth outcomes

2017

Self Cite

View full text Add to dashboard Cite

show abstract

“…Birth weight and small for gestational age were used rather than gestational age alone as predictors along with the hospital of care being accounted for as a random effect, by using methods similar to those described previously. 7,28,29 We determined the statistical significance of the observed heterogeneity of outcome change over time by incorporating study period and study group interactions. A P , .05 for the interaction term would indicate evidence of study group effect.…”

Section: Discussionmentioning

confidence: 99%

Implementation Methods for Delivery Room Management: A Quality Improvement Comparison Study

Lee¹,

Powers

Bennett³

et al. 2014

PEDIATRICS

View full text Add to dashboard Cite

WHAT'S KNOWN ON THIS SUBJECT: Quality improvement (QI) studies generally do not account for concurrent trends of improvement and it is difficult to distinguish the impact of a multihospital collaborative QI project without a contemporary control group. WHAT THIS STUDY ADDS:A multihospital collaborative QI model led to greater declines in hypothermia and invasive ventilation rates in the delivery room compared with an individual NICU QI model and NICUs that did not participate in formal QI activities. abstract BACKGROUND: There is little evidence to compare the effectiveness of large collaborative quality improvement versus individual local projects. METHODS:This was a prospective pre-post intervention study of neonatal resuscitation practice, comparing 3 groups of nonrandomized hospitals in the California Perinatal Quality Care Collaborative: (1) collaborative, hospitals working together through face-to-face meetings, webcasts, electronic mailing list, and data sharing; (2) individual, hospitals working independently; and (3) nonparticipant hospitals. The collaborative and individual arms participated in improvement activities, focusing on reducing hypothermia and invasive ventilatory support.RESULTS: There were 20 collaborative, 31 individual, and 44 nonparticipant hospitals caring for 12 528 eligible infants. Each group had reduced hypothermia from baseline to postintervention. The collaborative group had the most significant decrease in hypothermia, from 39% to 21%, compared with individual hospital efforts of 38% to 33%, and nonparticipants of 42% to 34%. After risk adjustment, the collaborative group had twice the magnitude of decrease in rates of newborns with hypothermia compared with the other groups. Collaborative improvement also led to greater decreases in delivery room intubation (53% to 40%) and surfactant administration (37% to 20%). CONCLUSIONS:Collaborative efforts resulted in larger improvements in delivery room outcomes and processes than individual efforts or nonparticipation. These findings have implications for planning quality improvement projects for implementation of evidence-based practices.

show abstract

“…1-3 The US maternal mortality ratio has increased steadily from 7.2 per 100,000 live births in 1987 to 17.8 per 100,000 live births in 2011. 4 Moreover, approximately 25% of women suffer some type of childbirth-related morbidity, 5, 6 and severe maternal morbidity (e.g. blood transfusion, disseminated intravascular coagulation, hysterectomy, organ system failure) has increased significantly over the past 15 years.…”

Section: Introductionmentioning

confidence: 99%

“…blood transfusion, disseminated intravascular coagulation, hysterectomy, organ system failure) has increased significantly over the past 15 years. 6, 7 Racial and ethnic disparities in maternal morbidity and mortality are well documented, 5, 7, 8 and provider factors such as incomplete or inappropriate treatment have been associated with preventable progression of maternal morbidity to severe morbidity or death. 9 …”

Section: Introductionmentioning

confidence: 99%

Effect of time of birth on maternal morbidity during childbirth hospitalization in California

Lyndon

Lee

Gilbert

et al. 2015

American Journal of Obstetrics and Gynecology

Self Cite

View full text Add to dashboard Cite

Objectives This observational study aimed to determine the relationship between time of birth and maternal morbidity during childbirth hospitalization. Study Design Composite maternal morbidities were determined using ICD9-CM and vital records codes, using linked hospital discharge and vital records data for 1,475,593 singleton births in California from 2005-2007. Time of birth, day of week, sociodemographic, obstetric, and hospital volume risk factors were estimated using mixed effects logistic regression models. Results The odds for pelvic morbidity were lowest between 11PM and 7AM compared to other time periods and the reference value of 7AM-11 AM. The odds for pelvic morbidity peaked between 11AM and 7PM [Adjusted Odds Ratio (AOR) 1101-1500=1.07 (1.06, 1.09); 1501-1900=1.08 (1.06, 1.10)]. Odds for severe morbidity were higher between 11PM and 7AM [AOR 2301-0300=1.31 (1.21, 1.41); 0300-0700=1.30 (1.20-1.41)] compared to other time periods. The adjusted odds were not statistically significant for weekend birth on pelvic morbidity [AOR Saturday=1.00 (0.98, 1.02); Sunday=1.01 (0.99, 1.03)] or severe morbidity [AOR Saturday=1.09 (1.00, 1.18); Sunday=1.03 (0.94, 1.13)]. Cesarean birth, hypertensive disorders, birthweight, and sociodemographic factors that include age, race, ethnicity, and insurance status, were also significantly associated with severe morbidity. Conclusions Even after controlling for sociodemographic factors and known risks such as cesarean birth and pregnancy complications like hypertensive disorders, birth between 11PM and 7AM is a significant independent risk factor for severe maternal morbidity.

show abstract

Maternal morbidity during childbirth hospitalization in California

Cited by 70 publications

References 24 publications

Thematic analysis of US stakeholder views on the influence of labour nurses’ care on birth outcomes

Thematic analysis of US stakeholder views on the influence of labour nurses’ care on birth outcomes

Implementation Methods for Delivery Room Management: A Quality Improvement Comparison Study

Effect of time of birth on maternal morbidity during childbirth hospitalization in California

Contact Info

Product

Resources

About