4. Implementation time Deciding on changes Getting agreement (and funding) Planning Communication and training Set-up time Pilot or big bang? Full implementation
5. Timescale of change The woman’s journey: VBAC Letter to each woman post CS VBAC clinic Management guidelines for labour 24 hour case review
6. Timescale of change The woman’s journey: VBAC Letter to each woman post CS VBAC clinic Management guidelines for labour 24 hour case review 3 years 6 months 28 days 28 days
7. Low hanging fruit Quick wins can be useful for morale credibility of project But: May not engage others May not be sustainable
8. How big will the change be? Is your change an improvement? You can only prove it if you measure it!
9. Measures: are wehaving the impact we intend? primary: reduced CS rate secondary: reduced PPH, reduced staff sickness, increased user satisfaction
10. Measures: are wehaving the impact we intend? final: reduced elective CS rate intermediate : increased numbers of women opting for VBAC at booking
11. Measures: are wehaving the impact we intend? primary: reduced CS rate secondary: reduced PPH, reduced staff sickness, increased user satisfaction or: final: reduced elective CS rate intermediate : increased numbers of women opting for VBAC at booking
12. First pregnancy and labour ?Target population: typically 45% all births of which >20% CS ?Where could we make an impact: Unplanned CS: in labour/prelabour pre-labour
13. VBAC pathway: once a CS always a CS Target population: multips 55% all births of which 1 previous CS - 15% Of which repeat CS indicated for 10% Emergency CS in labour 30% Vaginal birth in 70% Potential reduction in overall CS: 5%
14. Management of breech births Target population: 3% all pregnancies at term Breech diagnosed: 2% ECV: 50% success Reduction in CS rates: 1%
15. Optimising normality Target population: Low risk women opting for CDS care Women with some risk factors ? Optimal usage of MLU ?Transferrable skills in normality
