Services benefitting both mothers-to-be and their babies continue to expand at TriStar Centennial Women's Hospital and The Children's Hospital at TriStar Centennial. Both fall under the watchful leadership of Chief Operating Officer Amber Price, DNP, CNM, who joined the Nashville hospital in January 2019.
Rethinking the C-section experience means moms at the Women's Hospital now have the opportunity for immediate skin-to-skin contact with their baby. In July, the hospital rolled out C-section drapes designed to encourage bonding - a welcome approach to an otherwise sterile surgery experience utilized in nearly one-third of U.S. births. Traditionally, a solid drape separates mom and baby, and cold operating room temps mean baby is immediately placed in a warmer for up to 30 minutes.
"Babies can now go directly from incision to chest through a window in the section drape, after delayed cord clamping," said Price, who noted that staff recently completed training on the new product. "Our goal is always to keep mom and baby together, and these drapes help make that possible."
Recognized as a valuable ... but often pricey ... service, doula care is now offered free of charge to women delivering at the Women's Hospital. "Most people want that extra support person, but it can be very expensive out-of-pocket," said Price. "Doulas are a great benefit to patients no matter what kind of birth they want and help enhance the delivery experience."
A doula is now available on the floor in 12-hour shifts, and Price said the program has received tremendous interest from patients and doulas alike.
Calling the Midwife
Nashville experiences 2,000 midwife births each year, and that number continues to grow.
"Consumers are looking for low intervention births, particularly as information on maternal mortality becomes more widespread," said Price, a nurse-midwife.
To that end, the hospital is preparing to launch Centennial Midwifery in September and already has a list of waiting patients. The service will be provided on the Labor and Delivery floor and will include two dedicated midwife birthing suites designed for patients who want to avoid medical intervention unless necessary.
Rooms will include birth stools, yoga slings, birth tubs, special lighting and music, large walk-in showers and Murphy beds. The hospital offers nitrous oxide as a pain relief option. Patients also will have the option of early discharge, a common desire among families seeking midwifery.
"As a hospital system, our goal is to fill our basket with every possibly thing a patient could need, and we're filling ours with this new specialty," said Price. "We're also addressing policies to build an infrastructure around midwifery while safeguarding mom and baby in the process."
Better Odds for Mom & Baby
Tennessee's infant and maternal mortality death rates far exceed the national average, due in large part to a higher rate of opioid addiction and preterm births. The Tennessee Maternal Mortality report, released earlier this year by the Tennessee Department of Health, reviewed the 2017 data on women who died while pregnant or within one year of pregnancy and found a pregnancy-associated mortality ratio (PAMR) of 96.3 per 100,000 live births.
"This is absolutely a crisis in the state," said Price, who serves on the Tennessee Maternal Mortality Review Board. As an administrator, she regularly evaluates infrastructure and way to improve 24/7 access to obstetric care for high-risk moms, particularly in the ER.
"We've changed hospital policy to better address the needs of women who come in during or after pregnancy with concerns or issues that could be lethal," she said, noting TriStar Centennial's new acuity statement to help staff identify certain risks for maternal mortality. The hospital also hosted the region's first interprofessional collaborative summit on Aug. 7 - a quarterly event designed to promote communication and education around obstetric and neonatal transfers.
"We're all taking a hard look at the data and looking at how we solve this as a nation," Price said. "From a hospital perspective, we're addressing it by looking at safety protocols, communication and access to care. Those are things we can control, and we're getting more innovative about improving our safety matrix the best we can."
That includes addressing cesarean rates and postpartum hemorrhage, a leading cause of maternal mortality. While hospitals have traditionally guessed at the amount of blood lost, TriStar Centennial has adopted quantitative blood loss, which provides an exact measurement. They're also focused on training emergency staff to take the time to listen to patients with concerns to identify potential red flags and are building an opioid program that allows women to receive specialized care for themselves and their baby during and after pregnancy, including resources once they're home.
"We want to make sure we follow up and stay connected, and we're doing that by building a team of navigators and social workers to make sure every possible resource is being utilized," Price said. "Everything we do is about keeping mom and baby healthy and together."