Date of Graduation

Summer 8-8-2025

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Program

Kaiser cohort MSN capstone

First Advisor

Dr. Liesel Buchner

Second Advisor

Dr. Sara Horton-Deutsch

Abstract

Abstract

Problem: Cesarean birth rates for nulliparous, term, singleton, vertex (NTSV) pregnancies in the United States continue to exceed the Healthy People 2030 goal of 23.6%, resulting in preventable maternal and neonatal complications and higher healthcare costs.

Context: This quality improvement (QI) initiative was conducted in a high-acuity labor and delivery unit in California’s Central Valley, an area characterized by maternal health disparities, high rates of comorbidities, and limited access to prenatal care. The goal was to reduce the NTSV cesarean rate to 18.0% by July 31, 2025.

Interventions: Guided by Kotter’s 8-Step Change Theory and the Plan-Do-Study-Act (PDSA) framework, interventions included implementing a Labor Support and Cesarean Decision-Making Checklist, conducting structured interdisciplinary huddles, enhancing staff education on non-pharmacological pain relief methods, optimal patient positioning and improving workflow integration through a Labor Support Cart and visual patient identification tools.

Measures: Outcome measure focused on the NTSV vaginal birth rate. Process measures include documentation of labor support techniques. Balancing measures assessed NICU admissions and operative vaginal deliveries to ensure patient safety.

Results: Since the implementation, the NTSV vaginal delivery rate was 17% in May and increased to 29.90% in June, with an overall average of 22%. Non-pharmacological labor support was used in 43% of cases, and labor support techniques during the second stage were notably high at 76%. NICU admission and operative delivery rates remained within safety parameters.

Conclusions: The project is ongoing, and data collection is in progress. During the quality improvement project, the following was observed: standardizing labor management through interdisciplinary collaboration, structured communication tools, and non-pharmacological labor interventions produce mixed results and replication.

Keywords: NTSV cesarean reduction, labor support, non-pharmacologic interventions, checklist, quality improvement, interdisciplinary collaboration, maternal outcomes

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