My Daughter was a first-time Mom with a history of Dysautonomia and Presents with POTS symptoms. My daughter has to be careful with fluid balance and nutritional balance. She had to be careful not to labor too long or too hard. She had to be careful getting an epidural. However, with the great care she received from the L and D staff, her delivery was uneventful. She had a beautiful experience, and she was in the best care. They kept my daughter and grandbaby safe, and no symptoms presented. Not only did they care for my daughter, but they also cared for me, reassuring me she was doing great and asking myself and my husband if we needed anything. There was not one person who didn’t walk by and ask if we were ok or if we needed anything. Hannah started her with a fast evaluation; in triage, when she got to labor and delivery, she met Meghan S in a beautiful, calm environment with lights and essential oils, and Lisa A., who encouraged my daughter to do it to push and not give up. Dr. Harrison and his team work with great expertise in caring for and delivering the baby. Dr. Kouri encouraged my daughter to take some Pitocin to not make her labor any longer and stress her body out any more than it had to be. Then Dr. Noriss, who did the epidural (which was a big concern due to POTS) he did it with such excellence and care. Then the baby was here, a beautiful girl, and Kara K cared for her postpartum with care and compassion. All the other team members also played big parts in this Most Beautiful Moment. I can’t thank this great team enough; I know they always go above and beyond and work so hard, but seeing it firsthand. I thank each and every one of the L and D staff for the care they give all their patients.

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Labor and Delivery, by nature, requires strong, clear communication, flexibility, and multi-disciplinary collaboration.  Nursing collaboration on Labor and Delivery has flourished over the past three years. The unit-based council is robust and routinely identifies opportunities for the team to support our patients with best practices, often above the standard of care established. Specifically, in the last year and a half, the Nursing team has been instrumental in moving forward and supporting the execution of successful quality and process improvement projects.  These projects recognize the importance of putting safe patient care at the center of all decision-making, allowing for the focus on timely interventions, allowing the multi-disciplinary teams to deliver exceptional care without exception for all patients.  The Urgent Cesarean section project - The objective of this project is to standardize the pre-procedure process for specific non-emergent unscheduled cesarean deliveries to decrease the decision to incision time and eliminate racial disparities in order to improve maternal and fetal outcomes.  The execution of the project's objective relied on collaboration with a multi-disciplinary team of stakeholders, including the nursing team from labor and delivery and the perinatal float pool. We decided on indications that require more rapid cesarean deliveries, created a standard workflow, and then implemented the process. Part of the standard workflow was the development by nursing of a communication pathway by creating a series of paging scripts for the multi-disciplinary team to activate resources in an efficient, effective way, eliminating certain mobilization factors, previously impacting timeliness to delivery.  An interrupted time series calculation was completed, with stratification by patient race and ethnicity. The primary measure was mean decision to incision time. The secondary outcomes were infant morbidity measured by Apgar at five minutes and maternal morbidity measured by quantitative blood loss.  We evaluated whether specific times were associated with improved outcomes. We analyzed 642 cesarean deliveries. The mean decision to incision time improved from 88 to 50 minutes from the pre- to the post-implementation period. The analysis demonstrated a significant reduction from pre- to post-implementation (beta=-31.2 minutes, p<0.01). The mean among non-Hispanic Black patients improved from 98 (95% confidence interval [CI] 73-123) in the pre- to 50 minutes (95% CI 46-55) in the post-implementation period. For Hispanic patients, the mean DI time improved from 84 (95% CI 66-103) to 49 minutes (95% CI 44-55) in the post-implementation period. When the cesarean was performed for fetal indications, infant Apgar scores were significantly higher in the post-implementation period compared to the pre-implementation period (beta=0.29, p<0.01). There was no association of a specific decision to incision time and Apgars. There was an association of less blood loss with times < 30 minutes and < 40 minutes. Results - Development and implementation of a standard algorithm to expedite decision to incision time for specific indications for unscheduled non-emergent cesareans led to a significant decrease in decision to incision time and eliminated racial disparities. The decrease in times was associated with improved infant outcomes. Nursing's role in this project and others on the L&D unit demonstrate our commitment as a team to our patients, their families, and the mission of BMC.