Including evidence-based midwifery practices in traditional obstetrical care can improve maternal and neonatal outcomes and help mitigate health disparities for minority women. In 2014, Saratoga Hospital began moving from a purely medical model of care to an integrated model, incorporating midwifery into its obstetrical care.
The transformation took place over five years and was successful due to the unwavering commitment of a team of advanced practice nurses, medical team members and hospital leadership. In 2014, hospital-employed midwives were not available to patients preparing to deliver. The initial program began with just three midwives and a dedicated advanced practice director of nursing. The team used change management principles and methodologies, including Kotter’s change management model, and slowly advanced the program to full implementation. Using a multidisciplinary collaborative model of care promoted teamwork and active engagement of staff with executive leadership.
By 2019, there were six nurse midwives and a fully integrated program, with 85% of vaginal births attended by midwives. The hospital achieved a 24.1% reduction in the primary cesarean rate from 17.4% in 2014 to 13.2% in 2019; the episiotomy rate was reduced by 76.8% from 18.1% in 2014 to 4.2% in 2019.
For more information, contact Carrie Barber, director, women’s health services, at firstname.lastname@example.org or 518.944.4366.