Improving Standardization of Care Using the Maternal-Fetal Medicine Units Network Vaginal Birth After Cesarean Calculation Tool

Abstract

Objective

To standardize care by implementing the Maternal-Fetal Medicine Units Network vaginal birth after cesarean (VBAC) calculation tool in clinical practice.

Design

Quality improvement project guided by the Plan-Do-Study-Act cycle.

Setting/Local Problem

Two outpatient obstetrics and gynecology clinics with need for a standardized process for potential VBAC candidates.

Interventions/Measurements

A standardized process was developed using the Maternal-Fetal Medicine Units Network VBAC calculation tool to promote shared decision-making. This process includes interventions aimed at training 100% of perinatal providers and ensuring that providers counsel 90% of women with a previous cesarean birth on birth mode options at the initial prenatal visit, use the tool before the 28-week prenatal visit, and provide counseling on scores to 90% of potential VBAC candidates. Success was measured by assessing the percentage of individuals meeting each intervention target.

Results

All seven providers received training. Birth mode options were discussed with 34 of 38 women (89.5%) with a previous cesarean at the initial prenatal visit. Of 22 women interested in a VBAC, 90.9% (n = 20) had predicted success scores calculated and documented, with all but 1 assessed before the 28-week prenatal visit due to a transfer into the practice at the 29-week prenatal visit. Of the 20 women counseled, 95% (n = 19) had their scores discussed. After counseling, 16 women opted to pursue a trial of labor after cesarean (TOLAC). Birth outcomes included nine repeated cesarean births for various reasons, two failed TOLACs, and one successful VBAC. Outcomes for four women are still pending at the time of this writing.

Conclusion

An improvement in standardization of care surrounding counseling VBAC candidates was observed after implementation of this quality improvement project. Adherence to screening and discussion of birth mode options for women who had a previous cesarean birth demonstrates the clinics’ commitment to delivering evidence-based care.