Promotion of Safe
Vaginal Deliveries
To promote safe vaginal delivery for all women presenting with a nulliparous, term, singleton, vertex pregnancy (NTSV) and thus decrease NTSV cesarean delivery rates to <23.6% (Healthy People Goal 2030)[9] in all participating Tennessee hospitals by Summer 2024.
Tennessee Hospitals Work towards the Healthy People Goal of 2030 in promotion of safe vaginal deliveries
In early 2023, 35 hospitals throughout the state joined TIPQC with the goal of decreasing the cesarean rate to 23.6% for women presenting with nulliparous, term, singleton and vertex (NTSV) pregnancies to align with the Healthy People Goal of 2030. Cesareans are one of the most popular surgeries in the United States despite being associated with increased risk of hemorrhage, infection, uterine rupture, and longer recovery time. After more than 18 months of hard work, the Promotion of Vaginal Delivery project moved into sustainment in September 2024.
Hardin Medical Center achieved the Platinum QI rating which consisted of active project participation including huddles and coaching calls, monthly outcome and structure data capture, data driven QI work, clinical change implementation, and reaching the state goal of <23.6% NTSV cesarean delivery rate and <23.6% NTSV cesarean delivery rate after induction of labor for at least 2 of the previous 6 months.
Eight (8) hospitals received the gold achievement having reached 4 out of 6 of the above criteria, which included:
- Baptist Memorial Hospital – Tipton
- Greeneville Community Hospital
- Johnson City Medical Center
- Maury Regional Medical Center
- Newport Medical Center
- Regional One Health
- Riverview Regional Medical Center
- West Tennessee Healthcare – Volunteer
Nineteen (19) teams received the silver achievement.
- Ascension Saint Thomas Midtown
- Ballad Health Bristol Regional Medical Center
- Baptist Memorial Hospital for Women
- Baptist Memorial Hospital – Union City
- Cookeville Regional Medical Center
- Erlanger East Hospital
- Franklin Woods Community Hospital
- Indian Path Community Hospital
- LeConte Medical Center
- Methodist Medical Center of Oak Ridge
- Morristown Hamblen Healthcare System
- Tennova North Knoxville
- Tristar Centennial Medical Center
- Tristar Horizon Medical Center
- Tristar NorthCrest Medical Center
- University of Tennessee Medical Center- Knoxville
- Vanderbilt Tullahoma- Harton
- Vanderbilt University Medical Center
- West Tennessee Healthcare Dyersburg
Seven (7) teams were awarded a bronze achievement.
- Erlanger Baroness Hospital
- Fort Sanders Regional Medical Center
- Jackson- Madison County General Hospital
- Methodist LeBonheur Germantown
- Parkwest Medical Center
- Sumner Regional Medical Center
Decreasing cesarean rates takes strong leadership, coordinated PDSA cycles and collaboration. Throughout these past 18 months, teams worked relentlessly to decrease the number of unnecessary cesareans and further improve care for Tennessee moms and babies. We are so proud of all the work all 35 teams put into this project! Congratulations to all teams!
Target Population
Nulliparous women with a term, singleton baby in a vertex presentation:
- Nulliparous = first delivery/birth or Para Zero (Para Zero defined as no history of a previous pregnancy that reached at least 20 weeks gestation),
- Term = ≥37 weeks gestation,
- Singleton = no twins or beyond,
- Vertex position = Cephalic position; no breech or transverse positions.
This population is also known as the NTSV population.
- Ascension St Thomas Midtown*
- Ballad Health Bristol Regional Medical Center
- Baptist Memorial Hospital – Union City
- Baptist Memorial Hospital for Women*
- Baptist Memorial Hospital Tipton
- Cookeville Regional Medical Center
- Erlanger East
- Erlanger Health System
- Fort Sanders Regional Medical Center
- Franklin Woods Community Hospital
- Greeneville Community Hospital
- Hardin Medical Center
- Indian Path Community Hospital
- Jackson Madison Co. General Hospital
- LeConte Medical Center
- Maury Regional Medical Center
- Methodist LeBonheur Germantown Hospital
- Methodist Medical Center Oak Ridge
- Morristown Hamblen Healthcare System
- Newport Medical Center
- Niswonger/Johnson City Medical Center
- Parkwest Medical Center
- Regional One Health*
- Riverview Regional Medical Center
- Stonecrest Medical Center*
- Sumner Regional Medical Center
- Tennova North Knoxville Medical Center
- Tristar Centennial Medical Center*
- Tristar Horizon Medical Center
- Tristar NorthCrest Medical Center
- University of Tennessee Medical Center*
- Vanderbilt University Medical Center
- Vanderbilt Tullahoma-Harton Hospital
- West Tennessee Healthcare Dyersburg Hospital
- West Tennessee Healthcare Volunteer Martin Hospital
*Denotes a Pilot Team
State Project Leaders
Danielle Tate, MD, MBA and Connie Graves, MD led this project.
Dr. Tate is a maternal fetal medicine specialist at the Baptist Memorial System. She is an Associate Professor of Obstetrics and Gynecology at the University of Tennessee Health Science Center and the TIPQC Maternal Medical Director.
Dr. Graves has been involved with TIPQC since its inception and is a Maternal Fetal Medicine specialist. Dr. Graves is the Medical Director, Tennessee Maternal Fetal Medicine, Director of Perinatal Services, St. Thomas Health, Co-Director of the Comprehensive Perinatal Cardiac Clinic, St. Thomas Health, Professor – University of Tennessee, Clinical Professor – Vanderbilt University, and Adjunct Professor – Meharry Medical College. She also serves on many state and national boards and is widely published.
TIPQC is actively recruiting devoted health care professionals, community leaders and patient and family partners to further our mission of improving health outcomes for mothers and babies in Tennessee.