From left: Dr Peter Neil, A/Prof Ryan Hodges, Nadine Murray, Dr Sasha Skinner, A/Prof Daniel Rolnik, and Dr John Regan.
A remarkable Monash Health project that has significantly improved outcomes for women and their babies has been recognised on the international stage, with midwifery lead Nadine Murray travelling to the US to share the success story.
In 2019, the Consultative Council on Obstetric and Paediatric Mortality and Morbidity identified a series of poor neonatal and maternal outcomes related to operative vaginal births (OVB) in Victoria. An OVB is when the use of an instrument is required to assist the vaginal birth of a baby.
As a result, a dedicated Monash Health taskforce of obstetricians, midwives, paediatricians, anaesthetist and consumers led by obstetrician Dr Peter Neil was set up to improve safety of OVBs across our Monash Health sites.
Dr Neil says the final moments before birth can be dangerous and anxiety provoking for both mothers and staff, particularly if the baby is becoming stressed or stuck in the birth canal.
“Our expert panel comprising of midwives and doctors was tasked with reducing the physical and emotional trauma that has long been associated with these operative vaginal births.”
“Our new safety bundle comprehensively addresses all aspects of OVB and takes teamwork to a new level,” he says.
The team developed a new Safety Bundle for OVB in a truly multidisciplinary manner. This safety bundle was rolled out in August 2022, introducing significant changes for teams in our birthing suites and operating theatres. These include:
- A routine team time out prior to OVBs taking place
- A formal checklist during the operation to improve communication
- Recommending and upskilling staff in bedside ultrasound to confirm fetal head position
- A birth experience survey which enables the teams to reflect and implement any changes that will improve patient experience.
In a short space of time, the impact has been clear to see. Research has shown that when used, the Safety Bundle reduces neonatal morbidity from 31 percent to 24 percent and significantly fewer babies are delivered in an unexpected position, from 3.5 percent to 0.9 percent.
Nadine Murray, the midwifery manager at Monash Medical Centre, was a co–founding member of the task force, leading the development and implementation of the bundle. For Nadine herself, the introduction of the OVB Safety Bundle has been the most pivotal project she has seen put into practice during her 21 years as a midwife.
“I have seen a change in work culture, in uniting our multidisciplinary team and an improvement in outcomes for both mother and baby,” says Nadine.
In October this year, Nadine presented the Safety Bundle and its successes to an international audience at the Society to Improve Diagnosis in Medicine conference in Cleveland, USA.
Furthermore, at the recent ASM of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists in Perth, a presentation by Obstetrics and Gynaecology Registrar Dr Sasha Skinner on the Safety Bundle was awarded the prestigious Best Free Communication (Aldo Vacca) award.
Dr Skinner led the rollout of the Safety Bundle and credits the success of the program to the commitment of the maternity teams at Monash Health to improve outcomes for mothers and their babies.
“We are immensely proud of how Nadine represented Monash Health and the importance of women’s health research. Her presentation in Cleveland was extremely well received.”
“All the teams have embraced these changes together and supported each other to improve patient safety and experience,” said Dr Skinner.
Director of Maternity Services and Program Director for Women’s and Newborn Associate Professor Ryan Hodges says this project is a wonderful example of how senior decision making can be led by any member of the team and that the team members all have different skills to bring in, delivering the very best care to our patients.
“We are now doing this all day every day at all four of our maternity sites. This project is now set to spread across Victoria as the new standard in maternity care.
“Our next challenge is to take the principles we have learnt in senior decision making and try it out in other healthcare settings in Monash Health,” he says.
Congratulations and thank you to all our Monash Health maternity teams for their commitment to improving outcomes for mothers and their babies.
Approved by: Associate Professor Ryan Hodges, Director of Maternity Services and Program Director for Women’s and Newborn