Hourly “Huddles” Improve Care for Birthing Mothers

Hourly “Huddles” Improve Care for Birthing Mothers

By Jess Clarke

Once a woman gets to the pushing part, or second stage, of labor, it can take anywhere from a few minutes to several/many hours for the baby to emerge. The longer labor lasts, the greater the possibility that medical professionals and patients will miscommunicate or not communicate at all. And that can lead to bad outcomes.

Researching inpatient obstetrics, NU School of Nursing Assistant Professor Jessica Wood has developed a protocol to manage second-stage labor, one that improves safety by ensuring regular communication and documentation. Her work already has drawn interest from hospitals.

“All it takes is one birth where the baby is negatively affected for you to make a change,” Wood says. She says the premise of her protocol is to eliminate the “tunnel vision,” where patients don’t know what’s happening and doctors, certified nurse midwives and nurses may be unclear about fetal well-being.

“This process ensures that they actually verbally discuss what’s happening.”

Wood completed the project for her doctoral program at Duke University, where she recently earned her Doctorate of Nursing Practice. She is in the process of publishing her work.

Among other courses and duties at Norwich, Wood teaches maternal child health and coordinates a maternal child health clinical rotation for students at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., where she conducted the research.

During the three-month study last year, the hospital instituted Wood’s protocol and documentation template. The process called for “second-stage team huddles” when the mother’s cervix was dilated 10 centimeters. Doctors, nurses, and the patient would meet hourly and have their discussions documented to ensure that both mother and baby were doing well.

“The plan of care must include the patient’s understanding and agreement to the plan. That’s a shift in management, because the patient generally isn’t included in the decision-making process,” says Wood, who started teaching at Norwich in 2008 as an adjunct professor.

The documentation template is a detailed checklist of the mother’s vital signs and temperature and the baby’s heart rate and other criteria used to generate discussion among the doctor or certified nurse midwife, nurse, and patient. The procedure alerts doctor and nurses to possible problems.

“It definitely has the very high potential to ensure that the right decision is made at the right time,” Wood says. “It’s implemented so nurses, providers, and patients will clinically evaluate where the mom is and where the baby is and determine where they need to go [next].”

In some cases, a Caesarean section or other procedure may be required.

“The protocol at Dartmouth-Hitchcock seems to have helped decrease the likelihood of miscommunication and missing things at 2 a.m. when all these things seem to happen,” Wood says.

She surveyed 30 mothers before discharge, and most felt they were included in decision-making during labor.

Wood’s research reflects the type of innovation—in scholarship and other areas—for which Norwich is known.

“Her research is taking health care to a whole other level in designing models of intervention and observation in the health care setting,” says Ann Marchewka, interim program director of the Norwich School of Nursing.

Wood’s students have observed the team huddles at Dartmouth-Hitchcock, which still uses the protocol and template.

She has recruited Dartmouth-Hitchcock nurses to be clinical instructors at the hospital for Norwich students and works to get students practicums there.

“They’re impressed with the quality of the nursing student that comes out of Norwich, and they want to hire them,” says Wood, who works in the birthing center and as emergency-room nursing supervisor at two other hospitals.

Teaching is another way she shares her passion for nursing.

“I love watching students’ ‘aha’ moments when something clicks for them,” Wood says. “I tell them the sky is the limit in this profession. To have them get passionate about it, too, that’s what I like to see.”