During labor things said can get lost in the rush – like a patient not knowing an incoming doctor’s name at the start of a new shift. Or sometimes patients worry about where their doctors are and if their personal concerns during delivery are being addressed.
It’s why a program called TeamBirth has been implemented at Dartmouth Health’s member hospitals with labor and delivery services.
TeamBirth was developed by Ariadne Labs, a health systems research center with the Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health. It addresses the health complications, mistreatment and high maternal mortality rates seen in the United States.
According to Ariadne Labs, 80 to 90% of patient harm comes from miscommunication between doctors and patients, with higher risks for Black and Indigenous people.
New Hampshire is the fifth state in the country to implement TeamBirth to all of its hospitals.
Dr. Emily Donelan is the medical director of the birthing pavilion at Dartmouth Hitchcock Medical Center, which launched their plan earlier this month. She said TeamBirth involves doctors, patients and their support teams, like doulas and midwives, writing out birth plans and important information on a whiteboard. It’s a way to make sure everyone is on the same page and patients feel empowered.
“I think the real goal is to prevent the telephone,” Donelan said. “That often happens in hospitals where the patient says something to the nurse, and then the nurse comes to the doctor, and then the doctor goes to the patient, but they're not all in the same room simultaneously, and things can get lost.”
The whiteboard is just a tool for discussions patients and doctors will have with each other as labor begins. Donelan said that at various points during the delivery, especially when major decisions are made, doctors and patients will huddle at the patient’s bedside and discuss steps and options. The aim, she said, is to focus on the patient.
Doctors will ask the patient’s preferred name, how they want themselves and their baby to be treated, and encourage patients to use the whiteboard themselves – writing down questions, concerns and important information.
“So really eliciting their goals, their hopes, their dreams for their labor to make sure that before we jump into the plan and the decision making, we're really centering what they want from this experience and hearing their voice first,” Donelan said.
Foundation for Healthy Families, the New Hampshire Perinatal Quality Collaborative and Unravel Healthcare are spearheading the TeamBirth initiative which is expanding to all hospitals with a labor and delivery unit in the state.
Exeter Hospital started implementing TeamBirth in 2024.
So far, the hospital has received positive feedback from patients who say they’ve felt heard and respected, says April St. Hilaire, director of The Family Center, The Center for Reproductive Care & Maternal Fetal Medicine at Exeter Hospital.
“Even in patients that don't have the best outcomes, so to speak, like, let's say they end up with a C-section versus a vaginal delivery, which happens, they still felt like they had a wonderful experience and were very well cared for,” St. Hilaire said.
St. Hilaire said it’s the shared decision making, as opposed to a patient being debriefed after a major decision is made, that can help healthcare providers earn trust.
Concord Hospital is rolling out TeamBirth this coming April.
Melissa Devine, director of Concord Hospital’s Women and Children's Value Stream, said they’ve been building towards the launch of TeamBirth since October. She said TeamBirth isn’t an earth shattering shift – it’s really making sure everyone is on the same page during a significant life event.
“As we travel through the process, we know patients want transparency,” Devine said. “They want to be able to understand time frames. ‘When is my provider going to see me?’ And all of those little moments build the trust and just build the essence of making sure that everyone is on the same page when things matter most.”
Devine said Concord Hospital will also have prenatal services modeling TeamBirth at Laconia starting from six weeks gestation to after the first year of a newborn’s life.
