Q & A from December 4, 2015 Webinar
Q: Where can I find the bundles?
A: http://birthtools.org/RPC-Bundles-Toolbox and click on “read more” at the bottom of
the page
Q: What is the address of the resource page for this initiative?
A: http://birthtools.org/RPC-Collaborative-Participants-Member-Info
Q: How does Intermittent Auscultation (IA) work for second stage? Currently we require
continuous monitoring during second stage of both fetal and maternal heart rate.
A: You can find an excellent resource about implementation of IA at
http://birthtools.org/MOC-Assessing-Fetal-Well-Being-TOOLBOX
Model Policies
Intermittent Auscultation of Fetal Heart Rate PowerPoint (Denver Health)
Denver Health Clinical Care Guideline: Intermittent Auscultation of the Fetal Heart
Rate (also includes Algorithm)
And here:
Position Statements/Related Guidelines/Toolkits
AWHONN Monograph: Fetal Heart Rate Auscultation, 2nd Edition
This practice monograph describes how to perform fetal heart rate auscultation and
discusses the benefits and limitations of intermittent auscultation (IA).
Intermittent Auscultation for Intrapartum FHR Clinical Bulletin (ACNM)
Link to PDF of the ACNM Clinical Bulletin: Intermittent Auscultation for Intrapartum
Fetal Heart Rate Surveillance. This clinical bulletin reviews how to perform and interpret
intermittent auscultation and provides evidence-based information about patient
selection for IA.
Q: Have there been any studies comparing rates of primary CS in NTSV moms who have
had prenatal care in groups, v. moms who had individual prenatal care?
A: I have submitted this question to my “gurus of centering research.” I will post the reply
as soon as I have it.
Q: Can we implement more than one bundle?
A: Yes! We would suggest starting with one and then adding the second as you develop
your buy in from staff. There is good overlap in content between the Comfort and Coping
and Progress of Labor Bundles. We look forward to hearing about your selection process in
future webinars.
Q: Exactly what data should we be collecting as we go along in 2016?
A: The “master” data collection form is now posted under Other Updates at the bottom of
the page
http://birthtools.org/RPC-Collaborative-Participants-Member-Info
Q: Are you collecting baseline data on how well the items in the bundle are already
being implemented at our sites?
A: No, except in the case of the deliverables – if you already have some items on the
deliverables list indicated, you’ll indicate that, but we’re not going to have you collect the
variables and the data for the whole of 2015 so you wouldn’t be able to do that
comparison –I can check with the vendor to see if you could do that on your own.
Q: Is the baseline data we need to collect from 2014, 2015 or both?
A: 2015
Q: Apgar: Is this 5 minute Apgar score?
A: Yes
Q: Is the balancing measure of Apgar <7 just for the NTSV population?
A: Yes, just for NTSV
Q: "NTSV Induction": Is this ALL NTSV births, or only vaginal? (I see the additional
category for "NTSV C/S").
A: The NTCV induction is for all births. It is the denominator for the NTSV Cesarean birth
rate which will be calculated for both women who did have induction.
We want you to be able to compare the NTSV cesarean birth rate for those women who
were induced and those who were not.
Q: Induction only or augmentation (re: the baseline data collection form?
A: Induction (any kind) only. In the full data collection we do look at any Pitocin in the first
and second stage of labor.
Q: Will all team members have access to the portal, or just CNM?
A: We'll be inviting one user from each site as the site administrator, but that site
administrator can invite others to be administrators at their hospital.
Q: When will we need to upload our baseline data?
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A: Ideally, we would like you to be ready to upload it during the 2nd week of January. We
realize that there may be a lag for December data but hope that you will upload baseline
data in advance of the Jan 28th meeting.
Q: Is administration of Pitocin for PROM considered an induction?
A: We have placed a link to the ReVitalize Definitions at http://birthtools.org/RPCCollaborative-Participants-Member-Info under Other Updates.
This should assist you to make decisions of this type:
Looking at the definitions for Induction of Labor, Augmentation of Labor and Pre-Labor
rupture of membranes will lead to your decision. For example if a woman has pre labor
ROM, no contractions and is admitted 24 hours later still not in labor, then yes, Pitocin
would be an induction, not augmentation.
If in the above case she had contractions on admission and was seen to be dilated via
speculum exam, it could be termed augmentation.
THIS is definitely a case of “do your best” as it is the classic definition of a “grey area.”
Early cervical change (required for a definition of labor) in someone with ROM and the
need for minimal cervical exams may not be clearly documented.
Q: Will we need IRB approval?
A: We may apply for an exemption from an accredited review board. This will depend on
how many of you will require IRB exemption or approval at your institutions. At a
minimum we’ll make a boilerplate “protocol” available to you in written form.
We intentionally selected aggregate data for upload to the portal so that we would avoid
the need for data sharing agreement and IRB approvals. At the same time, we realize that
each institution will have its own rules. We would encourage you to email Leslie directly if
you need to discuss this further. leslie.cragin@gmail.com
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