Childbirth is an exciting time. In most cases, moms and babies do just fine during labour and delivery, but if there are complications healthcare teams rely on each other to manage the situation with efficiency, timeliness and care.
Maja Tomas, Clinical Nurse Educator at Surrey Memorial Hospital, recently led a Fraser Health (FH) shared work team in developing a fetal health surveillance workshop. The team recognized the importance of frequently verifying fetal health surveillance interpretation, reviewing maternal risk factors and agreeing on the plan for every woman in labour. The team developed a new communication tool called “Baby Pause” to ensure these three components were covered at every handover or assessment by another team member.
Healthcare teams that have tried the new Baby Pause tool say it has brought a heightened level of awareness to the importance of clear and concise communication throughout all stages of childbirth.
“At any time during labour and delivery there may be changes in the status of the mom, the baby or both,” says Lynne Palmer, Clinical Nurse Specialist at Fraser Health. “We introduced Baby Pause so care givers would take a moment to communicate in a consistent way with each other.”
Similar to a checklist, Baby Pause calls attention to the following three key areas:
1. Review of risk factors
What risk factors do we already know for the mom and her baby? Have additional risk factors come up during labour?
2. Systematic evaluation of fetal well-being
What is the baby’s baseline heart rate? The mom’s heart rate? Has anything changed and do we need to monitor the baby more closely? What is the fetal heart rate pattern if electronic monitoring is used?
What are the next steps? Does the healthcare team agree on what those next steps are? Is the mom aware of what’s going to happen next?
Lynne says the Baby Pause “Leader” (primary Registered Nurse or Midwife in the delivery room) is responsible for prompting healthcare providers who enter the woman’s room to cover each step of Baby Pause and ensure all steps are complete.
“If the Pause Leader’s interpretation of the mom and baby does not align with other members of the team, Baby Pause opens up dialogue and fosters communication among the team.”
It’s during those times of disagreement that Baby Pause is most effective. By prompting the team to “pause,” discuss what they see and agree on a plan – every single time – the tool has enhanced how teams function in the delivery room.
In addition, Baby Pause is designed for use by all members of the healthcare team, including the mother, so she has a good understanding of what is happening with her and her baby.
“Some healthcare providers are hesitant to discuss their interpretations in front of the mother. I believe mothers should know that if we use the words “atypical” or “abnormal” to classify an electronic fetal monitoring tracing that it doesn’t mean her baby is atypical or abnormal. It means that we need to monitor her and her baby more closely, or it might mean there is a change in the management plan. Either way, she should be included in those discussions.”
Baby Pause initially launched at two pilot sites led by Clinical Nurse Educators Tanya Jantzen at Langley Memorial Hospital and Maja Tomas at Surrey Memorial Hospital. Their feedback from the pilot site implementations was used to modify Baby Pause, and the revised version has since become a key component of Fetal Health Surveillance Workshops at the eight perinatal sites in Fraser Health.
The team’s goal is for Baby Pause to become a quality of care standard. Lynne believes that, “Once it becomes routine for all care providers to do Baby Pause in the delivery room, patient outcomes will improve and we’ll see a decrease in safety events reported in BC PSLS.”
Congratulations to the fetal health surveillance workshop team for launching this innovative patient safety initiative! Stay tuned for more blog stories as Baby Pause continues to evolve across Fraser Health.
To learn more about Baby Pause, the Fraser Health team invites you to download their Baby Pause tool and Baby Pause posters (see links below). The posters can be adapted to suit your organization’s needs. If you find them useful, please let them know!
“Baby Pause” tool and posters:
- Baby Pause Tool
- Baby Pause poster – Tip 1
- Baby Pause poster – Tip 2
- Baby Pause poster – Tip 3
- Baby Pause poster – Tip 4
- Baby Pause poster – Tip 5
Tanya Jantzen is a Clinical Nurse Educator at Langley Memorial Hospital. You can reach her by email at Tanya.Jantzen@fraserhealth.ca
Lynne Palmer is a Clinical Nurse Specialist with the Perinatal Program at Fraser Health. You can reach her by email at Lynne.Palmer@fraserhealth.ca