Tennis star Serena Williams made headlines in 2017 not for a grand slam victory or even birthing her first child. She was in the news because of a pulmonary embolism after a c-section.
Williams, who had a history of clots and took heparin daily before her c-section, suspected what was happening based on her symptoms. Williams’ request for a CT scan and heparin drip were initially dismissed by a nurse, until a doctor agreed to perform the procedure. Several small clots were found in her lungs.
In an April 2022 Elle essay titled “How Serena Williams Saved Her Own Life,” Williams notes that Black people are about three times more likely to die during or after childbirth than white people in the United States.
She said, “Many of these deaths are considered by experts to be preventable. Being heard and appropriately treated was the difference between life or death for me; I know those statistics would be different if the medical establishment listened to every Black woman’s experience.”
Ann Borders, MD, MSc, MPH, from the Department of Obstetrics and Gynecology at Endeavor Health Evanston Hospital, could not agree more. She is part of a team that is studying a new communication technique at Endeavor Health called TeamBirth.
This approach is being evaluated as part of the “Improving Safety, Patient Experience, and Equity through Shared Decision-making Huddles” study, or the I’M SPEAKING study. Endeavor Health was awarded $7 million in funding from the Patient-Centered Outcomes Research Institute (PCORI) for its proposed study.
Prior work informed Dr. Borders that some patients did not feel listened to when they had their babies and some mothers said they did not want or did not understand the care that they received. Although most patients reported receiving respectful care during birth, not feeling heard when making decisions about their labor or birth process happened more often among Black patients and among patients with public health insurance.
Statistically, Black patients experience more complications during and around childbirth and more frequently die from these complications. Cesarean sections are more common for Black patients, leading to increased risk for potentially life-threatening complications.
The I’M SPEAKING study proposal aims to find a way to change these experiences through TeamBirth. 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 a nationally recognized model that uses best practices in communication, teamwork and clinical care to foster better communication between the clinical team and the person giving birth. It was developed by Ariadne Labs, a joint center for health system innovations at Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health in Boston.
Borders is a co-principal investigator of the I’M SPEAKING Study with Beth Plunkett, MD, MPH, from the Department of Obstetrics and Gynecology at Endeavor Health Evanston Hospital, as well as Co-Investigator and Director of Evaluation Emily White VanGompel, MD, MPH, from the Department of Family and Community Medicine, University of Illinois Chicago.
While most nurses start and end their day with team huddles and shift reports in addition to daily rounds, TeamBirth is all about shared decision-making. The huddles occur with the patient, provider and nurse during labor. During the process, the patients and providers together discuss the labor progress and note decisions and patient preferences on a white board in the labor room.
In partnership with the Illinois Perinatal Quality Collaborative (ILPQC), TeamBirth initiatives for the study will be implemented across 22 hospitals in Illinois. Dr. Borders is the executive director of ILPQC and has worked closely with patients, community stakeholders and hospital teams to successfully implement numerous quality improvement initiatives to improve health outcomes and reduce disparities for birthing patients in Illinois.
Funding for the study begins in August, and the first wave of TeamBirth implementation should start in fall 2025. The entire project will span five years. Throughout the process, patient input will guide the work with quarterly patient and community advisory meetings.
The team will summarize their findings for patients and hospitals that participated, and, based on their results, they will create a toolkit. With it, other organizations can adopt the most successful implementation strategies with the goal to improve the care of birthing persons, increase shared decision-making to improve patient experience of respectful care and promote reductions in unnecessary cesarean birth, especially for Black birthing patients.
“As executive director of ILPQC, a topic we regularly hear about from patient and community partners is the need to continue to improve respectful care, particularly active listening and shared decision-making. TeamBirth is a focused, simple model that has the potential to help birthing hospitals improve care and reduce disparities,” Dr. Borders said.
“It is important to study care models like TeamBirth to better understand how we can improve care and patient experience during birth for all patients, and specifically for Black birthing patients. PCORI has provided us funding because this work matters. We must do all we can to eliminate disparities in patient respectful care experience and eliminate disparities in birth outcomes.”
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