Improving Deliveries With Less Trauma to Mother and Baby

In 2013, the Department of Defense participated in the Partnership for Patients program to reduce iatrogenic (caused inadvertently by a physician or surgeon or by medical treatment or diagnostic procedure) patient harm. In a study to be presented, in the oral concurrent session at the Society for Maternal-Fetal Medicine's annual meeting, The Pregnancy Meeting™, researchers with Community Medical Center in Missoula, Montana; Uniformed Services University of the Health Sciences, Bethesda, Md.; and Wilford Hall Ambulatory Surgery Center, San Antonio, Texas, will present their study titled, SAFE PASSAGES implementation reduces perineal trauma.

Recognizing that some of the trauma and tears associated with labor could be reduced, a specific program for harm reduction was developed called SAFE PASSAGES. The SAFE PASSAGES term is memory prompt for a series of interventions for managing childbirth that reduce the chances and severity of childbirth trauma. For example the first "E" is "Eliminate midline episiotomy".

One military service used this program and other two services instituted other programs that encouraged reduced rates of harm in childbirth but offered no specific programmatic recommendations for reduction. This study evaluated the effectiveness of SAFE PASSAGES training on the incidence of perineal trauma in the Department of Defense.

Of the three programs reviewed, SAFE PASSAGES showed the greatest reduction in the rate of harm (63.6%) at the same time having a decrease in cesarean delivery rates. At hospitals where the SAFE PASSAGES program was implemented with on-site didactic and simulation training, the rate of severe perineal lacerations was reduced by over 300%.

"I believe that the principles taught and propagated in the SAFE PASSAGES program could go a long way toward keeping the cesarean rate down, even improving the rate, while reducing the overall risk of trauma in child birth" stated Merlin B. Fausett, M.D., maternal-fetal medicine specialist with the Community Medical Center and the presenter of the research at the SMFM annual meeting. Dr. Fausett continued, "If one considers a cesarean as trauma, these principles can really help reduce the risk of trauma to mother either through avoiding unnecessary cesareans or reducing trauma in vaginal birth while even potentially reducing the risk of trauma to babies as well.

The program includes training in support of forceps and vacuum deliveries and quality repair of tears when they do occur. This study definitively shows that applying the techniques taught in the SAFE PASSAGES program can really help to reduce the risk of harm to mother and baby during childbirth."

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Source-Eurekalert