By Sara McCloskey-Nieves  

There’s a lot to plan for when you’re expecting, but emergencies aren’t one of them.  

That’s why you want to make sure your care team is ready – with the best training and set of protocols in place – to keep you and your baby safe. 

A new state law recently passed in Virginia requires all hospitals and health care facilities involved with childbirth to implement “maternal safety bundles,” a set of protocols aimed at improving the health of pregnant people during and after delivery. 

VCU Health’s Obstetrics and Gynecology team was ahead of the curve and has been implementing maternal safety bundles since 2017. 

“This [law] will be especially helpful for hospitals who don’t see OB emergencies as frequently due to lower volumes of patients and will help all hospitals manage the rarer emergencies which can develop in pregnancy,” Emily Barrows, M.D., OB-GYN, VCU Health’s medical director for Labor and Delivery. “By having an OB emergency safety bundle in place, a health care team’s response to rare emergencies will be more automatic and standardized which is likely to lead to better patient outcomes in these situations.” 

“These bundles matter because they provide evidence-based, standardized approaches that ensure every birthing person receives consistent, high-quality care, no matter the circumstances,” said Holly Perkins, RN, FNP-C, nurse manager for Labor and Delivery at VCU Medical Center.  

We spoke with Barrows and Perkins about what safety bundles do and how they improve patient care. 

What is a safety bundle and what do they aim to do? 

Barrows: A safety bundle is a collection of evidence-based practices pertaining to a specific problem or clinical situation which are proven to improve outcomes when performed consistently. 

How are maternal safety bundles different than ones for other patient populations?  

Barrows: Maternal safety bundles typically pertain to pregnancy specific conditions like postpartum hemorrhage and pregnancy induced hypertension (high blood pressure). They can also pertain to more generalized conditions, like sepsis, in the setting of the unique physical changes of pregnancy. 

Perkins: We have standardized educational training for all team members on critical topics such as obstetric hemorrhage, hypertensive disorders of pregnancy, maternal mental health and maternal sepsis. These efforts empower our staff to respond confidently and swiftly to complications, improving both the health of pregnant people and their babies. 

How does VCU Health’s OB-GYN team implement safety bundles?  

Barrows: We determine which conditions and circumstances would benefit from the implementation of a safety bundle based on the recommendations of the Alliance for Innovation on Maternal Health and the Center for Medicare & Medicaid Services. Which particular bundles we prioritize are based on the unique circumstances and needs of our patients. 

When we determine that a specific set of protocols should be created, we have a group of nurses and physicians who work together to put together a safety bundle. The bundles may involve developing new protocols, practice guidelines, order sets and more. 

Once created, these procedures are presented to our perinatal practice committee for approval by a panel of obstetricians, perinatologists, neonatologists, anesthesiologists, midwives, nurses and pharmacists. 

How have you seen them make a difference for VCU Health patients? 

Perkins: Our implementation of maternal safety bundles has had a transformative impact on patient outcomes and overall care quality on our unit. 

We have hardwired key tools into our electronic medical record to guide and standardize care for every patient. These tools support timely recognition and treatment of hypertensive disorders, a leading cause of severe maternal morbidity and mortality. We have also integrated different technology in the operating room to measure blood loss. This helps us to implement a stage-based intervention approach to rapidly identify and address hemorrhage, significantly improving safety.  

Beyond these clinical safety measures, our patient-centered practices have also advanced. For example, our parent/newborn skin-to-skin contact rates following cesarean delivery have increased, which promotes immediate bonding and support for newborns as well as more success with breastfeeding. 

Discover everything you need to prepare for pregnancy and birth at VCU Health.

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