Date of Graduation

Summer 8-4-2026

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. Dave Ainsworth

Abstract

Background: Primary cesarean birth among nulliparous, term, singleton, vertex (NTSV) patients remained a persistent quality and safety concern in obstetric care. Unnecessary cesarean birth was associated with increased maternal morbidity, neonatal complications, prolonged recovery, higher healthcare costs, and adverse outcomes in subsequent pregnancies. Problem: A Northern California labor and delivery unit identified an elevated NTSV cesarean birth rate of 26.8%, exceeding the national benchmark of approximately 23%. Variability in provider communication, inconsistent labor management practices, and lack of standardized interdisciplinary collaboration contributed to this quality gap. Context: The project was conducted in a high-volume labor and delivery microsystem serving a diverse maternal population. Organizational strengths included leadership support, an established culture of safety, quality data infrastructure, and readiness to engage in evidence-based improvement initiatives aligned with Magnet principles. Interventions: A structured multidisciplinary communication bundle was implemented over a three-month period, including standardized SBAR communication, multidisciplinary labor huddles, structured bedside handoffs, and a labor management checklist aligned with evidence-based labor progression criteria. Measures: The primary outcome measure was the NTSV cesarean birth rate. Process measures included SBAR documentation compliance, labor huddle participation, and checklist utilization. Balancing measures included postpartum hemorrhage and neonatal intensive care unit (NICU) admission rates. Results: The NTSV cesarean birth rate decreased from 26.8% to 23.4%. SBAR compliance reached 93%, multidisciplinary huddle participation reached 88%, and checklist utilization reached 91%, with no increase in postpartum hemorrhage or NICU admissions. Conclusions: Structured multidisciplinary communication and standardized labor management practices reduced primary cesarean births while maintaining maternal and neonatal safety, demonstrating feasibility and potential for broader implementation.

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