In brief
A funded fellowship protocol that will use survey and registry data from 55 Washington hospitals to estimate whether the person-centered TeamBirth model changes perceived autonomy and Cesarean rates among low-risk patients; no results are reported yet.
What this article is about
Quick Answer
A funded fellowship protocol that will use survey and registry data from 55 Washington hospitals to estimate whether the person-centered TeamBirth model changes perceived autonomy and Cesarean rates among low-risk patients; no results are reported yet.
Student takeaways
Key Takeaways
- This is a funded fellowship study protocol, so it presents aims, rationale, and planned methods rather than results; it does not report whether TeamBirth changes outcomes.
- The authors frame the problem: compared with peer countries, US women more often experience unnecessary childbirth interventions, raising cost and the risk of complications and mortality.
- They cite prior work estimating 16 to 20 percent of US women experienced a form of mistreatment during pregnancy care, which may be associated with unnecessary interventions, birth trauma, and mortality.
- TeamBirth is a person-centered intervention placing the pregnant woman at the center of team-based decision-making, currently implemented across 55 Washington state hospitals; pilots showed feasibility and acceptability but not outcome effects.
- The plan has two aims: (1) estimate TeamBirth's effect on perceived autonomy in decision-making using a pre-post design and multiple linear regression, and (2) estimate its effect on Cesarean delivery among low-risk patients using a retrospective birth cohort and log-risk regression.
Student summary
Why This Research Matters
This abstract describes a funded research project, meaning a study plan rather than finished findings, that will examine a person-centered approach to childbirth called TeamBirth. The authors begin with a concern about maternity care in the United States. Compared with peer countries, pregnant and laboring women in the US are more likely to undergo unnecessary interventions during childbirth. These unnecessary interventions make childbirth more expensive and can raise the risk of complications and even death. The authors also cite a growing body of work estimating that between 16 and 20 percent of women in the US have experienced some form of mistreatment during pregnancy care, and they note that mistreatment may be linked to unnecessary clinical interventions, birth trauma, and mortality. Against this background, the researchers propose that a person-centered approach may be an antidote to disrespectful care, over-intervention, and poor health outcomes during the perinatal period, which is the time around pregnancy and birth. TeamBirth is the intervention at the heart of the study. It is a person-centered care model that places the pregnant woman at the center of a team-based decision-making process, so that she is an active partner alongside her clinicians. TeamBirth is currently being implemented across 55 hospitals in Washington state. The authors note that earlier pilot studies showed TeamBirth is feasible and acceptable to clinicians, but no study has yet tested whether it actually changes clinical outcomes or how women perceive their care. That gap is what this project aims to fill. The study has two specific aims. The first is to estimate how TeamBirth affects pregnant women's perceived autonomy in decision-making during childbirth, meaning how much say and control they feel they have. The second is to estimate the effect of TeamBirth on Cesarean delivery among low-risk pregnant women, comparing rates before and after the program was put in place. To do this, the researchers will use two data sources: patient surveys given during inpatient postpartum care, and chart-abstracted data from the Obstetrical Care Outcomes Assessment Program and the Washington State Hospital Association Maternal Data Center. For methods, the team plans a pre-post design, which compares outcomes before and after TeamBirth is introduced. For the first aim, they will use multiple linear regression to assess the change in perceived autonomy. For the second aim, they will use a retrospective birth cohort and log-risk regression to estimate the risk ratio, along with a 95 percent confidence interval, of Cesarean section given exposure to TeamBirth among low-risk patients. The project is also a fellowship, carried out by a PhD student in Maternal and Child Health with a minor in Epidemiology at the University of North Carolina at Chapel Hill, supported by a multidisciplinary team of mentors. For nursing students, this abstract offers several teaching points. First and most importantly, it is a research plan, so there are no results here; it does not tell us whether TeamBirth improves autonomy or reduces Cesarean deliveries. It should be read as a set of questions and methods, not as evidence. Second, it introduces person-centered and trauma-informed maternity care, which is highly relevant to nursing values of respect, autonomy, informed consent, and shared decision-making. Third, it shows how real-world programs can be studied using existing survey and registry data rather than a new randomized trial. Some cautions are worth emphasizing. A pre-post design without a separate control group can be affected by other changes happening over the same time period, so any future finding would need cautious interpretation. The topic touches sensitive experiences, including birth trauma and mistreatment; students should approach these with empathy and recognize that respectful, culturally safe, and trauma-informed care is a goal in itself, not only a means to lower Cesarean rates. Finally, because the work is limited to Washington state hospitals and a specific model, results, when they come, may not transfer directly to every setting. Overall, this is a thoughtfully designed plan to test whether centering the birthing person in decisions improves both experience and outcomes.
Source abstract
Study Overview
PROJECT SUMMARY/ ABSTRACT Significance: Compared to peer countries, pregnant and laboring women in the US are more likely to experience unnecessary interventions during childbirth, making childbirth more expensive while putting patients at an increased risk of adverse pregnancy complications and mortality. A growing body of work estimates that between 16-20% of women in the US experienced a form of mistreatment during pregnancy care, and mistreatment may be associated with unnecessary clinical interventions during childbirth, birth trauma, and mortality. A person-centered approach may be an antidote to disrespectful care, over-intervention, and poor health outcomes during the perinatal period. TeamBirth is a person-centered care intervention during childbirth that puts the pregnant woman at the center of a team-based decision-making process. TeamBirth is currently being implemented across 55 hospitals in Washington state. While pilot studies have shown that TeamBirth is feasible and acceptable to implement among clinicians, no studies have tested the association of TeamBirth on clinical outcomes or pregnant women’s perceptions of care. Specific Aims: This study leverages an ongoing intervention across 55 hospitals in Washington state to estimate the impact of TeamBirth on (1) pregnant women’s perceived autonomy in decision-making during childbirth and (2) Cesarean delivery among low-risk pregnant women before and after implementation of TeamBirth. Approach: The proposed analysis will utilize data from two data sources: (1) patient surveys administered during in-patient postpartum care and (2) chart abstracted data from the Obstetrical Care Outcomes Assessment Program (OB COAP) and the Washington State Hospital Association Maternal Data Center (WSHA-MDC). Using a pre-post design and multiple linear regression, aim 1 will assess the change in pregnant women’s perceived autonomy in decision-making before and after implementation of TeamBirth. Aim 2 will use a retrospective birth cohort and log-risk regression to estimate the risk ratio and 95% confidence interval of Cesarean section given exposure to TeamBirth among low-risk patients. Fellowship Information: The applicant is a PhD student in Maternal and Child Health and has completed a minor in Epidemiology at The University of North Carolina in Chapel Hill. Ms. Spigel’s application is supported by a multidisciplinary team of mentors with expertise in perinatal nursing, person-centered care, perinatal epidemiology, applied microeconomics, evaluation of maternal health interventions, and implementation of TeamBirth. Through coursework in maternal health, epidemiology, quasi-experimental methods, coupled with support from an exemplary team of mentors, the proposed training plan will assist Ms. Spigel in successfully completing her dissertation work, and achieving her long-term goal of becoming a successful independent researcher with expertise in the quality and experience of care during the perinatal period.
Evidence appraisal
Main Findings
- This is a funded fellowship study protocol, so it presents aims, rationale, and planned methods rather than results; it does not report whether TeamBirth changes outcomes.
- The authors frame the problem: compared with peer countries, US women more often experience unnecessary childbirth interventions, raising cost and the risk of complications and mortality.
- They cite prior work estimating 16 to 20 percent of US women experienced a form of mistreatment during pregnancy care, which may be associated with unnecessary interventions, birth trauma, and mortality.
- TeamBirth is a person-centered intervention placing the pregnant woman at the center of team-based decision-making, currently implemented across 55 Washington state hospitals; pilots showed feasibility and acceptability but not outcome effects.
- The plan has two aims: (1) estimate TeamBirth's effect on perceived autonomy in decision-making using a pre-post design and multiple linear regression, and (2) estimate its effect on Cesarean delivery among low-risk patients using a retrospective birth cohort and log-risk regression.
Practice transfer
Clinical Relevance
- Person-centered, team-based decision-making that keeps the birthing person at the center reflects core nursing values of autonomy, informed consent, and shared decision-making, regardless of this study's eventual outcome data.
- Nurses play a central role in respectful maternity care and can help reduce unnecessary interventions by supporting clear communication and shared decisions, while recognizing this proposal does not yet prove TeamBirth's effects.
- Awareness that a substantial share of women report mistreatment in pregnancy care should prompt nurses to prioritize dignity, trauma-informed care, and cultural safety in every birth encounter.
- Because the study is not yet complete, nurses should not present TeamBirth as proven to lower Cesarean rates or improve autonomy; it is a promising model still under evaluation.
- Findings, once available, would come from Washington state hospitals and a pre-post design, so nurses in other settings should interpret and apply any results cautiously.
Faculty notes
Educational Relevance
This NRSA fellowship abstract is a study protocol, ideal for teaching appraisal of observational, real-world evaluation designs and for distinguishing a plan from evidence. The clinical framing, unnecessary intervention, the 16 to 20 percent estimate of mistreatment in US pregnancy care, and links to birth trauma and mortality, opens rich discussion of respectful maternity care, autonomy, informed consent, and trauma-informed and culturally safe practice. TeamBirth, a team-based, person-centered decision-making model deployed across 55 Washington hospitals, anchors a conversation about implementation versus efficacy: pilots showed feasibility and acceptability, but effects on outcomes and perceptions are untested. Use the two aims to teach design and analysis vocabulary: a pre-post design with multiple linear regression for perceived autonomy, and a retrospective birth cohort with log-risk regression yielding a risk ratio and 95% confidence interval for Cesarean among low-risk patients. Prompt students to critique the pre-post approach (secular trends, no concurrent control, confounding), the reliance on registry and survey data (OB COAP, WSHA-MDC), and generalizability from a single state. Emphasize that centering the birthing person is a professional and ethical goal in its own right, independent of downstream outcome effects.
Critical appraisal
Limitations
- The abstract is a study proposal with no results, so it cannot support any conclusions about TeamBirth's effectiveness.
- The planned pre-post design lacks a concurrent control group, so secular trends and other changes over time could confound future findings.
- The work is limited to Washington state hospitals and one implementation of TeamBirth, which may limit generalizability.
Classroom use
Discussion Questions
- What does person-centered care mean in the context of childbirth, and how does TeamBirth try to achieve it?
- Why might unnecessary interventions during childbirth increase both cost and risk to patients?
- How should nurses respond to evidence that many women report mistreatment during pregnancy care?
- What is the difference between a study showing an intervention is feasible and acceptable versus showing it is effective?
- What are the strengths and weaknesses of a pre-post study design without a control group?
- Why is perceived autonomy an important outcome to measure in maternity care?
- How might using existing registry and survey data help or hinder this kind of research?
- What is a risk ratio with a 95 percent confidence interval, and why is it useful for the Cesarean outcome?
- How do trauma-informed and culturally safe care principles apply to childbirth?
- If TeamBirth improved perceived autonomy but did not change Cesarean rates, how would you interpret that?
Search-ready answers
Frequently asked questions
Does this study prove TeamBirth improves childbirth outcomes?
No. It is a funded study plan (protocol) describing aims and methods. It reports no results and cannot yet show whether TeamBirth improves autonomy or reduces Cesarean deliveries.
What is TeamBirth?
A person-centered care intervention that places the pregnant woman at the center of a team-based decision-making process during childbirth, currently used in 55 Washington state hospitals.
Why does the abstract focus on unnecessary interventions?
Because US women more often experience unnecessary interventions than in peer countries, which increases cost and can raise the risk of complications and mortality.
What does the 16 to 20 percent figure refer to?
It is a cited estimate of the share of US women who reported experiencing some form of mistreatment during pregnancy care, which may be linked to over-intervention, birth trauma, and mortality.
What is perceived autonomy in decision-making?
It reflects how much control and voice a woman feels she has in decisions about her own care during childbirth. It is one of the study's two main outcomes.
Why is a pre-post design a limitation?
It compares before and after without a separate control group, so other changes happening over the same period could influence the results and must be considered carefully.
What role do nurses have in this area?
Nurses support respectful, person-centered maternity care by promoting clear communication, informed consent, and shared decision-making, and by practicing trauma-informed and culturally safe care.
Can these ideas be applied outside Washington state?
The principles of person-centered care are broadly relevant, but any specific findings from this study would come from Washington hospitals and should be applied cautiously elsewhere.
Is this about lowering Cesarean rates only?
No. Centering the birthing person and providing respectful, trauma-informed care is a professional and ethical goal in itself, in addition to any effect on Cesarean rates.
Where can someone in distress about a past birth experience get help?
This summary is educational only. Anyone experiencing birth-related trauma or distress should reach out to their healthcare provider or local mental health and support services for professional help.