Seton Family of Hospitals: Where the Birth Trauma Rate Is Essentially Zero

This story originally appeared in IHI's 2008 Annual Progress Report.
Every mother’s child is the most beautiful baby ever born. And that was certainly the case for LaDonna Mathews-Claude, who recently gave birth to her fourth child, Richard Marcus Claude III, known as RC. “He’s perfect,” she says.
What Mathews-Claude doesn’t realize is how many other mothers are having perfect babies too these days in the Seton Family of Hospitals, thanks in part to a new protocol that has dramatically reduced the number of babies born with traumas or injuries associated with induced births. Seton is a multi-hospital network in central Texas with four hospitals providing obstetrical services.
Sometimes, of course, inductions are medically necessary, as was the case for RC’s mom. But too often, women are delivering babies before 39 weeks by choice. “Some women ask to be induced early because they are tired of being pregnant,” says Frank Mazza, MD, Vice President of Medical Affairs at Seton Medical Center in Austin, Texas. “Obstetricians like to be customer-focused, so they’ll do it. Or, in some cases, doctors schedule an induction so they can be sure to deliver the baby themselves.”
But not only does an induced birth require the use of powerful medication that can strain the baby’s circulation and oxygenation, it can also result in trauma to the baby. This is because induced labor is more likely to require the use of forceps and vacuum extractors, tools that can cause injuries ranging from lacerations to broken arms or even fractured skulls. Studies say this happens on average to 7.4 babies per thousand in the US.
In collaboration with IHI, Seton developed two new perinatal “bundles” designed to reduce the number of elective inductions, and improve the safety of medically necessary ones. Standardized order sets were developed to support the bundles, and customized systems were created at each site to ensure reliability. “We thought we could get our trauma rate down, but we never thought we would get close to zero. It turns out we were wrong,” says Mazza.  
Now, Seton has virtually eliminated elective inductions, and improved safety has reduced the birth trauma rate essentially to zero. “It is a very happy surprise,” says Mazza.
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