“Always PROVIDE”: 76 Florida hospitals commit to Promote Primary Vaginal Deliveries


Florida has the highest cesarean rate in the nation, and seventy-six Florida hospitals have responded by signing up to work to improve quality of care, create a culture that supports vaginal birth, and reduce their cesarean rate in low-risk, first time mothers.

The quality improvement project is called PROVIDE, or Promoting Primary Vaginal Deliveries Initiative, and it launched at a state-wide meeting of over 250 people in October 2019.

The Florida Perinatal Quality Collaborative’s (FPQC) PROVIDE Initiative, supported by the Florida Department of Health and the Alliance for Innovation in Maternal Health (AIM), focuses on applying evidence-based interventions to maternity care to ultimately reduce unnecessary cesareans that may have negative impacts on the health of mothers and babies.

Florida’s cesarean rate for NTSV, or nulliparous, term, singleton, vertex pregnancies, is higher than the national average.

Forty-two of the hospitals participated in the first round of PROVIDE, which launched in 2017. An additional 34 have joined on for PROVIDE 2.0. Energy was high as all 76 hospitals who applied with teams committed to reduce primary c-sections attended the kick off meeting in Orlando.

After hosting three regional trainings to orient Florida hospitals to the issue, covering the PROVIDE Initiative’s foci, and driving home why it is crucial to reduce cesarean sections; the FPQC spent the PROVIDE 2.0 kick off focusing on key messages on how to tackle this significant maternal health issue.

Special guest from the California Maternal Quality Care Collaborative, Dr. David Lagrew, told the group that “Culture eats strategy for lunch,” and that the most important thing is “a culture that values vaginal delivery.” He presented lessons from how their state West Coast has been lowering their cesarean rates.

David Lagrew, MD, giving a keynote presentation to Florida hospitals

Dr. Lagrew emphasized that research in California has shown that reducing their cesarean rate has not impacted adverse outcomes in newborns, and he emphasized the power of sharing provider-level data. He emphasized that physicians with lower rates are more likely to: choose inductions wisely and carefully, have lower numbers of failed inductions, less latent phase admission, and are more present during labor and pushing.

More lessons learned and pearls of wisdom from hospitals who have been successful in lowering their cesarean rate were shared during a Success Stories panel session that included representatives from hospitals who participated in round one of PROVIDE. The audience enjoyed hearing directly from their peers on what challenges they met and were able to overcome, what changes were most successful, and concrete ideas that can be implemented in other institutions.

Bill Sappenfield, Director of the FPQC, moderated a panel with Florida PROVIDE hospitals successful at reducing their NTSV cesarean rate

Clinical co-lead for PROVIDE, Dr. Karen Bruder, presented on change management for PROVIDE, and how to engage and obtain buy-in from physicians. FPQC nurse consultants Betsy Wood and Nancy Travis led a session on how teams could begin to plan their projects and teams left with individualized   plans to get started in their own organization.

The FPQC team walked the attendees through some of the resources and types of assistance available to them as participants in the initiative, including ways to track their progress with data, participation in small group coaching calls and on-demand expert technical assistance, and an online resource tool box.

FPQC Staff wearing the PROVIDE Initative’s “6 is the New 4” buttons: Bill Sappenfield, Linda Detman, Betsy Wood, Emily Bronson, Estefania Rubio, Nicole Pelligrino, and Lori Reeves

To learn more about the Promoting Primary Vaginal Deliveries Initiative, visit www.fpqc.org/provide.

Article written by Emily A. Bronson and FPQC staff.