The Out-of-Hospital Birth Committee of UWNQC was created in November 2013 and was charged with:
1) Analysis of the current state of out of hospital births in Utah
2) Identification of maternal and neonatal safety issues related out of hospital birth
3) Creation of statewide action items addressing the recognized safety issues.
Out-of-hospital birth was selected as a UWNQC focus because of the growing percentage of planned out-of-hospital births in Utah, the potential for wide impact in both urban and rural areas, the required collaboration among obstetric and pediatric providers across the State, and the goal of reducing both maternal and neonatal morbidity and mortality. While out-of-hospital births are still the minority of births in Utah, the trend is increasing and these births now comprise more than 2% of the total births, approximately 1,200 births annually. These numbers underestimate the scope of the issue, since planned out-of-hospital births that ultimately deliver in the hospital are tallied as hospital births.
1. Analyze the Current and Longitudinal Data for Out-of-Hospital Births in Utah
1a. Annual Report on Out-of-Hospital Births in Utah The Out-of-Hospital Birth Committee, working together with the Utah
Department of Health, Maternal Child Health Bureau, has published "Out-of-Hospital Births in Utah, 2010-2012: A Descriptive Review" (found here). This first report examines recent trends and characteristics of planned OOH births among live, term births (≥37 weeks) without lethal anomalies in Utah, 2010-2012. A publication of biannual reports on out-of-hospital births in the State of Utah will be critical to inform ongoing safety initiatives and assess trends over time.
1b. Collection and Analysis of New Birth Certificate and Fetal Death Data
The current Utah birth certificate does not identify planned out-of-hospital births that ultimately deliver in the hospital; however, in January 2016 new items on the Birth Certificate will be collecting this data. These births were included in the hospital delivery group and bias maternal and neonatal morbidity and mortality data. Based on this observed limitation, the Out-of-Hospital Birth Committee successfully petitioned the State to add a field to the birth certificate to identify planned home deliveries that were transferred to the hospital. This data collection will be included in future reports. Fetal death certificates (including intrapartum deaths) do not currently include location of delivery. The Committee will petition for this data to be added to the death certificate. This data will be analyzed and incorporated in future reports.
2. Identification of Maternal and Neonatal Safety Issues Related to Out-of-Hospital Birth and Hospital Transport
The Out-of-Hospital Birth Committee, working together with the Perinatal Mortality Review Committee, will work together to identify maternal and neonatal safety issues related to out-of-hospital birth and hospital transport. The data analysis accomplished in Aim 1 will critically inform this process.
3. Creation of Statewide Action Items Addressing the Recognized Safety Issues
The following items were identified from our efforts to date and from national data. The above aims will enable additional statewide action items to be selected.
3a. Creation of a Standardized Maternal / Neonatal Transport Form
These forms have been created and can be found under "Out-of-Hospital Births Resources" or by clicking here. They include key information required for safe maternal / neonatal transfer of care. A standard and familiar medical handoff format, SBAR (Situation, Background, Assessment, Recommendation), is used. Elements of this form will be used for prospective data collection. One outcome measure will be percentage of planned out-of-hospital birth transports for which the form is used. A confidential survey has been developed to assess the effectiveness of this tool from a multi-disciplinary perspective (found here).
3b. Development of Educational Materials for Obstetric Providers and Pregnant Women
This information will outline recommended transport guidelines for planned out-of-hospital births. The audience will be pregnant women as well as transferring and receiving obstetric providers. This effort will include suggested language for clear and respectful communication. Seminars and discussions will be held at regional hospitals (labor and delivery and newborn intensive care units), birthing centers, and obstetric and pediatric practices. The above action items will be piloted in hospitals currently participating in UWNQC. As the collaborative grows, these items will be modified and expanded to include all hospitals in the State of Utah.