Continuing to PROVIDE during the pandemic: Florida hospitals meet to promote primary vaginal deliveries


The Mid-Project Meeting for the Florida Perinatal Quality Collaborative’s Promoting Primary Vaginal Deliveries (PROVIDE) Initiative looked a little different than meetings in the past. Held virtually on November 19, 2020, the meeting attracted more than 130 participants including hospital representatives, healthcare organizations, and other stakeholders.

The meeting was an opportunity to assess initiative-wide progress, brainstorm future strategies to reduce low-risk primary cesareans in the state, and reinvigorate participating hospitals teams’ quality improvement efforts.


The meeting highlighted the progress hospitals and providers are making towards decreasing nulliparous, term, singleton, vertex (NTSV) cesarean birth rates, as well as the status of quality improvement activities impacting their rates.   Keynote speakers shared information on efforts to promote vaginal births safely.

FPQC understands COVID-19 has impacted many of the teams’ level of participation.  FPQC Director, Bill Sappenfield, MD, MPH, CPH opened the meeting and reminded attendees that the FPQC is available to assist teams with tools, resources, and clinical experts to re-invigorate their PROVIDE initiative.

Leah Swann, patient advocate

To focus on the patient impact of our work, guest Leah Swann told her story of having placenta accreta with her fourth cesarean section, with massive hemorrhaging and loss of her uterus. She emphasized how important avoiding a first cesarean is, and advocated for more VBACs. She noted that of the nine women in her accreta support group, she was the only one to survive their birth experience.

FPQC Data Manager Estefania Rubio, MD, MPH presented the data on how hospitals state-wide are doing with their quality improvement process changes and impact so far in the PROVIDE Initiative. Overall, many hospitals are showing progress towards meeting ACOG standards for labor induction and dystocia but more work needs to be done, especially for patients who never reach 6 centimeters dilation.

Two nationally recognized keynote speakers discussed timely topics around PROVIDE.

Dr. Sindhu Srinivas

Sindhu Srinivas, MD, MSCE, Professor, University of Pennsylvania, presented “Continuing to Promote Primary Vaginal Delivery During the Pandemic: It Can Be Done!” She shared strategies to promote vaginal birth during the COVID-19 pandemic. She also introduced a labor induction calculator, developed at the University of Pennsylvania Perelman School of Medicine, that predicts the likelihood of a cesarean section for a certain subset of women with an unfavorable cervix.

Dr. Joyce Edmonds

Joyce Edmonds, PhD, RN, Professor, Boston College, shared her current research on nurse cesarean rates and emphasized the nurse’s performance variation and attributes that contribute to effective practices to promote vaginal birth.  

One of the highlights of the meeting was the breakout sessions, where attendees discussed timely topics with expert facilitators.  Topics included creative team education strategies during the pandemic; inductions, including scheduling, bishop scoring and cervical ripening; implementation of huddles/checklists; provider practice changes and intrapartum interventions to promote vaginal birth.  The conversations were robust and many ideas were generated.

“I like that we got to hear perspectives from other hospital systems and what was working and how they were implementing interventions and education.”

– Meeting attendee

FPQC announced plans to extend the initiative to make up for time when hospitals may not have been able to focus on PROVIDE, due to the COVID-19 pandemic. The FPQC team is thankful for all the team’s participation, especially this year!

“I feel reinvigorated to take this information back to my unit to share with my team.”

– Meeting attendee

More information on the initiative, project resources, and speaker presentations can be found at For more information, please e-mail