Discoveries Magazine


Beyond the Bench

CASE STUDY 5: In the Delivery Room


LAB: Labor and delivery rooms
INVESTIGATOR: Marle Shelton-Hoff, RN-C,
MSN, nurse manager, Labor and Delivery and
Maternal-Fetal Care units, Department of Obstetrics and Gynecology
STUDY: Rock and Roll to reduce cesarean section rates
PARTNERS: Labor and delivery nurses
KEY EQUIPMENT: An exercise ball

When you add rock and roll — literally — to labor, the result can be a faster delivery and a more satisfying childbirth experience. This is the outcome of a study in which Cedars-Sinai nurses helped women change positions during labor by using an exercise ball to move the birthing process along with gentle rocking and rolling.

Cedars-Sinai is at the forefront of an effort to pay closer attention to what women want during this milestone. Based on research in labor and delivery rooms, and a national survey of patient preferences, innovative practices are emerging. So is the realization that improving patient satisfaction can also make childbirth safer.

“Women are increasingly dissatisfied with hospital childbirth services,” says Kimberly Gregory, MD, MPH, vice chair of Women’s Healthcare Quality and Performance Improvement in Cedars-Sinai’s Department of Obstetrics and Gynecology. Rising rates of cesarean sections, falling rates of vaginal birth after a cesarean, and a decreasing ability to participate in decisionmaking are major concerns. “While observing hospital safety policies, we can also pay closer attention to patient preferences,” she adds.

Dr. Gregory, also director of Maternal-Fetal Medicine, has extensively researched c-sections and helps lead a national effort to reduce such deliveries, which increase complications for both mother and newborn. She says the Rock and Roll study, led by Marle Shelton-Hoff, RN-C, MSN, nurse manager in the Labor and Delivery and Maternal-Fetal Care units, is an example of how Cedars-Sinai is getting results. In the study, a group of specially trained nurses helped first-time moms in labor shift every 30 to 40 minutes to one of nine positions. This significantly reduced c-sections as well as average hours in labor. The method was so effective, and patient reaction so positive, that all Cedars-Sinai labor and delivery nurses have since been trained in it.

Another study, based on a national Internet survey, revealed a gap between women’s birth plans and outcomes. Participants’ top priorities were avoiding interventions and medications, receiving immediate skin-to-skin contact with their babies, and having a calm and supportive environment. “Cedars-Sinai is quickly translating these findings into efforts to promote greater choice while still prioritizing safety and evidence-based care,” Shelton-Hoff says. Through community outreach, she encourages women to develop birth plans and educates them about options for hospital deliveries. The medical center even offers orientations to integrate patients’ doulas into the care team. Dr. Gregory’s research shows that a mother’s anxiety and the risk of cesarean delivery are reduced when she has a trusted person at her side during childbirth.

“For women with uncomplicated pregnancies, labor and delivery can be accomplished through a variety of approaches. This makes childbirth the ultimate preference-sensitive condition,” Dr. Gregory says. “This research will help us close the gap between what women want and what hospitals deliver.”

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