Pregnancy, labor and delivery is a multifaceted specialty with a variety of potential complications for the mother and baby. As pregnant patients become more complex, Endeavor Health’s network of physicians and facilities have responded.
“We have seen a shift where it became more common for birthing people to have increased chronic medical complexities,” said obstetrician-gynecologist Erica Smith, MD, vice chair of the Obstetrics/Gynecology Department at Endeavor Health Highland Park Hospital.
“This change has made pregnancies more complex. We as a system responded in a robust manner and work really hard to address safety standards and protocols.”
Finding ways to minimize risks
Dr. Smith explained the increased effort began officially in 2020, when Highland Park Hospital’s Obstetrics/Gynecology Department identified increased risk factors. In response, over the last couple of years, the OB/GYNs collaborated with other disciplines — like nursing, anesthesia, blood bank — to adopt practices to minimize these risks.
For hemorrhages (increased bleeding) for instance, the physicians studied qualitative and quantitative approaches to prevent and/or be prepared for hemorrhages.
Now, each patient is given a score based on their hemorrhage risk factors, such as previous history, diagnoses or other conditions that contribute to the possibility of increased bleeding. The labor and delivery unit also performs multidisciplinary huddles every four hours to talk about current patients, including changes in status and scores.
“For hemorrhages, we review labs, past history, comorbidities and other factors that might make a woman more susceptible to increased bleeding with delivery,” Dr. Smith explained. “We talk about if a woman has a low hemoglobin count and if she should have two IV access sites or just one. We want to review every detail as a team to minimize those risks.”
The role of OB hospitalists
Since 2020, Highland Park Hospital’s OB hospitalist program provides coverage and continuity of care. In 2023, the program became more vigorous to offer 24/7 OB hospitalist physician coverage. The hospital now employs physicians specifically for OB emergencies.
“It happens almost daily that multiple women are laboring at the same time. If a delivery happens at the same time, OB hospitalists are ready to step in if a physician is occupied with another delivery,” Dr. Smith said.
The OB hospitalists work 12-hour shifts and meet with families at the start of their shifts. Dr. Smith believes that when women meet the physician who is part of their care team — who might deliver their baby if their own obstetric-gynecologist is busy delivering another baby — it eases anxiety.
Stories of labor and delivery
At Highland Park Hospital in 2018, Ashley Bonnes delivered her son, Wyatt, at 35 weeks and 3 days and hemorrhaged after delivering. She had an immediate D&C for a partially retained placenta and credits the fast action of the physicians and nurses with saving her life. Bonnes had been diagnosed with intrahepatic cholestasis of pregnancy (ICP) around 33 weeks, and women with ICP have an increased risk of hemorrhaging.
When Bonnes was medically cleared for a second pregnancy, she again chose Highland Park Hospital because of the positive experience at her first delivery and extra level of care. Her daughter, Ella, was born in 2022. Bonnes noted she was made to feel part of the decision-making process throughout her experience.
At Highland Park Hospital, mothers and their birthing partner are considered team members, and steps have been taken to enhance communication. “We spend a lot of time looking at how do we get to the place where patients feel like they are getting the best care and that they are valued members of the team,” Dr. Smith added.
A similar example of the predictable and unpredictable occurrences that Endeavor Health staff prepares for can be found in a recent Today.com story. When a laboring mother experienced an amniotic fluid embolism (AFE) and went into cardiac arrest, her doctors at Endeavor Health Evanston Hospital stepped in. AFEs come with no warning signs, so education and communication are the only paths to being prepared.
At Endeavor Health, physicians and nurses are trained with modules and simulations to walk through the steps of what would happen with an AFE, shoulder dystocia, hemorrhage, code blue or other complications. Classroom training alone is inadequate, so the team also debriefs after incidents to talk about what went well and what needs improvement.
Helping laboring women feel heard
Women will have an additional layer of involvement in their labor and delivery plan when TeamBirth starts at Highland Park Hospital. The TeamBirth approach is being evaluated as part of a study at Endeavor Health. The initiative trains hospital teams to listen to patients during their labor, understand the needs and preferences of each patient, and make decisions with the patient, not for the patient.
“TeamBirth is all about shared decision-making, so we are so excited for the initiative and study to begin here,” Dr. Smith said. “With every action that we take, we want to talk about what we can learn and what is an actionable item for improvement.
Dr. Smith cited that engagement in Illinois Perinatal Quality Collaborative initiatives, like Promoting Vaginal Birth (PVB), can improve outcomes.
“It has been exciting to watch staff actively participate since making PVB a huge initiative in 2020, and to see the improved patient satisfaction and outcomes for mother and baby,” she said.
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