From left: Movita Harrigan, Soriannie Lugo, with son Elvin, and Matt Medina

When Soriannie Lugo gave birth to her son Elvin at the Brigham a few months ago, her care team ensured that she was at the center of the process. They asked about her preferences, wrote them on a whiteboard in her room and included her in regular huddles with all team members as she moved through labor.

Lugo was the first BWH patient to participate in TeamBirth, a national program designed to improve communication and patient-centered care.

“I had an amazing experience at the Brigham with TeamBirth, and I really felt involved in my care,” she said.

Brigham and Women’s Center for Labor and Birth launched the program in April to ensure that people giving birth and the clinicians caring for them have shared input and understanding into decisions during labor and delivery.

“We really want our patients to feel that they are part of the conversation and part of the process of their own health and delivery,” said Nawal Nour, MD, MPH, chair of the Department of Obstetrics and Gynecology (OB-GYN). “What makes TeamBirth so unique is it really puts patients at the center of the conversation. It all starts with the patient, and we’re there surrounding and helping them through the birthing experience.”

While patient- and family-centered care has long been a hallmark of many birthing centers around the country, including the Brigham, that model isn’t always implemented in a standard way. TeamBirth seeks to change that by creating a playbook for equity — one that hopes to dismantle barriers through best practices and empower clinical teams with the tools to reliably make every birthing patient an active participant in their care.

“There is national concern that current obstetrical birthing and midwifery practices are not uniformly respectful of the patient’s voice, so it’s important for the patient to have a say in the birthing process,” said Robert Barbieri, MD, FACP, FACOG, interim chief of Obstetrics and chair emeritus of Obstetrics and Gynecology and Reproductive Biology. “TeamBirth elevates the birthing person’s voice and elicits their preferences, symptoms and lived experiences to inform their care.”

For example, TeamBirth establishes clear structures around communication: The clinical team meets with the patient upon admission to understand their goals and concerns. When plans change or something needs to be clarified — be it for the physician, nurse, midwife, patient, partner or doula — it’s communicated to everyone at the same time.

“Communications may have become triangular and segmented in the past, with one conversation between the nurse and provider, a separate conversation between the provider and the patient and then another conversation between the nurse and the patient,” Nour reflected. “We want circular conversations where we’re all around the patient and making sure that they truly understand what is going on.”

Simple, Effective Interventions

TeamBirth is a project of Ariadne Labs, a joint center for health systems innovation at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health that aims to save lives and reduce suffering by creating scalable, systems-level health care initiatives.

“Miscommunication or insufficient communication among health care professionals is one of the leading causes of medical errors and patient harm,” said Karen Manganaro, DNP, RNC-OB, C-ONQS, clinical educator for the Mary Horrigan Connors Center for Women and Newborns. “TeamBirth helps to ensure that communication is clear and consistently includes the birthing person and their chosen support team, nurse and delivering provider.”

The program, which seeks to provide a safe and dignified birth for all, centers on including patients in all communications and decision-making. In addition to incorporating regular interdisciplinary team huddles with the clinical team and patient, an important component of TeamBirth is the use of a shared whiteboard in each patient’s room that documents the patient’s preferences and plan, as well as team members names and planned huddle times.

“TeamBirth makes care more patient-friendly and patient-focused,” said Barb Stabile, MSN, RN, RNC-OB/EFM, professional development manager of Obstetrics. “It increases patient understanding by adding plans and patient wishes and preferences to the birthing planning board — visible for patients and everyone entering the room.”

Since the launch of the program, this model of care is no longer a goal but a standard in the Center for Labor and Birth, said OB-GYN Katherine Economy, MD.

“TeamBirth has given a name, language and systematization to how we all want to practice and be our very best selves for our patients,” Economy said. “In doing that, it uplifts patient care and improves the quality of our own practice.”

Positive Outcomes

Although the program is in its early stages, the Center for Labor and Birth is monitoring outcomes and gathering patient feedback to measure success. Early data indicate patients report feeling more included, heard and respected.

Ariadne has reported positive results from trial periods at other hospitals, as well, including high rates of patients reporting clear communication and the opportunity to openly share preferences with providers, as well as a high rate of clinicians who felt the program improved care through enhanced communication, teamwork and shared decision-making. Ariadne has also seen significant reductions in maternal mortality and morbidity with TeamBirth.

The next step in the rollout is to scale the principles of the TeamBirth model to antepartum and postpartum units. In addition, leaders noted that the principles could be applied more broadly for patients in other areas.

“I think TeamBirth will revolutionize the way we include patients in their care,” said midwife Matt Medina, MSN, CNM. “It is really changing the way our patients feel empowered to communicate about their own care.”

In addition to elevating patient care, the project has been empowering for clinical teams in CWN.

“This program gives us additional tools to help us really put the patient at the forefront,” said OB-GYN Sarah Little, MD.