TriStar Centennial Women's Hospital committed to better outcomes for high risk obstetric patients

High-risk complications occur in six to eight percent of pregnancies, leaving women prone to medical complications and increased risk of maternal mortality. In fact, the US is the only industrialized nation with a consistently rising maternal death rate, currently 17.4 of 100,000. Amber Price, DNP, CNM, chief operating officer at TriStar Centennial Women's Hospital, said a programmatic approach is key to reducing maternal mortality while still providing individualized birthing experiences for high-risk patients. "Regardless of whether women present from a private physician, midwife or the ER, we have a team of experts prepared no matter how difficult her situation," said Price. The hospital, which welcomes 3,500 babies annually, also provides dedicated maternal and NICU transport regionally via ground and helicopter, and is staffed by a team of seven high-risk maternal fetal specialists as well as cardiologists and others trained in obstetrics. Their NICU team also is available for deliveries in outlying hospitals when transportation isn't possible. "Our infrastructure build is significant, because our team members work together to achieve optimal outcomes with a deliberate focus on prevention of maternal mortality," Price said.

Addressing maternal mortality

Amber Price, COO

Dr. Harold Bivins

Harold Bivins, MD, medical director of Maternal Fetal Medicine at TriStar Centennial Women's Hospital, said African Americans face a mortality rate three times higher than the national average, prioritizing the need for education and early intervention in minority communities. "Transparency is so important, so we emphasize really listening to patients when they come in, which is often through the ER where they're already afraid," Bivins said. "We put ourselves in the shoes of patients to understand and address their immediate needs. So much of their comfort level depends on past experiences with the medical community, so just talking to them, being honest and explaining risks is so important." Despite Tennessee's shocking one in 1,000 maternal mortality rate, the Nashville hospital maintains a mortality rate of zero.

Better outcomes

The TriStar hospital also is making strides in resuscitation of preterm babies, resuscitating as early as 22 weeks. Price noted the hospital's 42 percent survival rate at 22 weeks gestation - up from a national average of less than five percent a few years ago. "We make sure every baby has an optimal chance of survival," she said. Improved outcomes also require establishing relationships with outlying hospitals, including those in rural communities. A one-stop call from any partnering physician launches multi-disciplinary coordination and access to TriStar's Transfer Center. "There's projected to be more and more high risk pregnancies based on an increase in pre-existing medical conditions, so we're revving up staff and working with physicians whose patients might need to see someone like me," said Bivins, who works with patients in rural communities as well as visitors to Music City. High-risk patients also work with a navigator to guide them through their prenatal journey. Navigators coordinate tools including virtual classes and tours, and connect patients to specialists when necessary.

Meeting demand

Now in phase two of a four-phase renovation, the hospital recently completed a high-risk OB unit and lobby remodel (see below), and anticipates two more high-risk delivery units complete by fall 2021. Birthing suites include murphy beds, slings, squat bars, and walk-in showers and labor tubs to accommodate the growing number of women requesting hydrotherapy during labor. Midwifery - now preferred by 20 percent of women - also is available in the ER and L&D. "So many women want minimal intervention or to be mobile during labor, so any patient here has that option," Price said. As part of their ongoing quality initiative, the hospital also oversees a committee focused on avoiding unnecessary surgeries such as C-section, even when a woman is higher risk. "Moms often worry about losing their birth experience, and extenuating circumstances create a fear that the birth you envisioned isn't possible," Price said. "With our individualized care experience, our team sits down to prepare everything we can before the birth, so high-risk doesn't mean you won't get the experience you're looking for. Everyone collaborates to give the patient the birth she wants with a safety net in place for assistance if it's necessary." Bivins said today's OB patients are more informed than in years past, and that physicians have adopted a more transparent approach. "Consumers are looking for shared decision making," he explained. "We're partners in care, so it's not a one-way street. We can't predict a birth but can commit to the fact that you'll have a say in how things will happen. We have a basket with everything in it, and we only pull out what we need for each patient."

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