LEBANON — Dartmouth Health is rolling out a new program that aims to keep patients giving birth at its hospitals at the center of their own care and involved in decision-making.
Team Birth is a model of health care that centers around having regular meetings between providers, nurses and patients from intake until patients are discharged. While in the birthing suite, patient information, questions, preferences, plans for future steps and meetings are documented on special whiteboards.
DH launched Team Birth at Dartmouth Hitchcock Medical Center on March 4 and was set to go live with the program at Cheshire Medical Center in Keene Tuesday and Southwestern Vermont Medical Center in Bennington, Vt., on April 1.
“Our hope is that we’re empowering patients to come in and be a more vocal part of their care,” Dr. Emily Donelan, medical director for the birthing pavilion at DHMC, said last week.
Meeting regularly with providers and visibly documenting patient progress are not new concepts at DHMC, but providers hope by introducing a structured system, these kinds of meetings become the “standard of care” and “every patient feels the benefit of these team discussions during every encounter that they have,” Donelan said.
Writing updates and progress on whiteboards in patient rooms also forces providers to cut out jargon and to write in language a patient can understand.
When a patient is admitted to the birthing pavilion they will have an admission meeting, called a “huddle,” with their midwife or doctor and a bedside nurse. The group documents information including all of the members of the team, what the patient prefers to be called, concerns, and plans for the birthing process and, crucially, when the group will plan to “huddle” next.
“Setting patients’ expectations” is an important part of the process, Donelan said.
Huddles are called as needed and by anyone, including the patient. The providers involved depend on where a patient is in the process, for example an anesthesiologist, pediatrician or lactation specialist might be the main decision-maker in the huddle, Molly Hanlon Taub, the birthing pavilion and lactation services nurse manager, said.
Huddles might be planned based on a certain amount of time passing, another benchmark or when making a major decision, such as whether to induce birth or switch to cesarean section delivery.
Team Birth is a health care model developed by Ariadne Labs, a research center run jointly by Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health. The program launched at four “pilot” hospitals in 2018 and now is online at nearly 300 hospitals in the U.S., according to Ariadne Labs.
The goal of Team Birth is to “improve communication, teamwork and shared-decision-making” and “give every person a chance at a safe, dignified childbirth experience.”
People in the United States are more likely to “face mistreatment, serious complications, or death” while giving birth than in other high income countries and outcomes are worse for Black or Indigenous people, according to Ariadne Labs. The vast majority of patient harm comes from “failures in communication and teamwork.”
Eighty-nine percent of Black and 89% of Indigenous patients reported high patient autonomy with Team Birth compared to 63% and 68% respectively without Team Birth, according to Ariadne Labs’ data.
After nurses and providers heard a presentation on Team Birth at a conference two years ago, Dartmouth Health worked with Ariadne Labs to train providers and bring the model to the birthing pavilion.
Team Birth will soon be the model of care at every birthing hospital in New Hampshire, thanks to a project underway through the Concord-based nonprofit Foundation for Healthy Communities.
A cohort of six New Hampshire hospitals is set to launch the program in April, with six more to follow in April 2027.
Providers still deliver babies at 15 New Hampshire hospitals, including Exeter Hospital, which launched Team Birth in 2024, DHMC and Cheshire Medical Center, according to the foundation.
“It’s important to us (…) to make sure patients everywhere in the state are getting that same level of care no matter whether they’re delivering at Dartmouth Hitchcock Medical Center or they’re delivering at a smaller hospital,” Rori Dawes-Dyment, senior director for rural quality improvement at the foundation, said Monday.
Team Birth “really boils down” to improving communication to help prevent medical errors, Dawes-Dyment said.
Dawes-Dyment declined to say the total cost of implementing Team Birth, but said that the foundation received grant funding and an anonymous donation to cover most of the cost and participating hospitals are paying $1,000 to $1,500 to launch the program.
Without the cost sharing, Dawes-Dyment said hospitals would be on the hook for “much more” money. DH is involved with the Foundation for Healthy Communities project but Dawes-Dyment said the hospital opted to set up its own contract to include Southwestern Vermont Medical Center, which is not eligible for the New Hampshire program.
DHMC Spokesperson Cassidy Smith declined to say how much the health network spent to implement the program, but said the money came out of the OB-GYN’s budget.
Gifford Medical Center, the only other birthing hospital in the Upper Valley, will not be launching Team Birth any time soon, Heather Johnston, a midwife who leads the birthing unit at the Randolph hospital, said last week.
“We really design systems that are around this concept of family-centered care,” Johnston said. “Family-centered care and shared decision-making.”
In general, Johnston said the “principles” of Team Birth are “actually really good” and focus on “keeping the patient part of the whole process,” but Gifford is already designed around those principles and did not need to spend money on the training.
The birthing unit’s small size with only three midwives, including Johnston, also makes it easier to keep providers informed on every patient, she said.
“From the moment people book their first visit with us, we have charting systems that are designed to create continuity,” Johnston said. “We have communication systems that are designed for continuity. We meet regularly to make sure everybody’s up to date on people’s needs and some of that discussion does go on without the patient necessarily, but everybody is apprised of it.”
Midwives at Gifford also have regular meetings called “checkpoints” with the patient present. As for whiteboards, she said some patients have said they would find them irritating or unhelpful.
“I hate it when patients, people, come out of anything wondering what the heck just happened to me,” Johnston said. “Yes, it can be overwhelming, and sometimes people need to catch up and stuff, but seriously that’s my job.”
Though not right for Gifford, Johnston said Team Birth can have benefits such as keeping patient communication at the center of care and reminding providers to speak directly with patients throughout their stay.
“It can either be done as a performative measure (or) it can be done with really this is our intent and we’re going to use these tools,” Johnston said. “I’ve seen it done both ways.”
After only a week and a half, DHMC providers said it was too early to say exactly how the Team Birth system was working or to identify any trends, but Donelan and Hanlon Taub said it seemed to be going well.
“Our entire team is really committed to continual improvement, so we are just continuing to find the right way for us,” Hanlon Taub said last week. “But it’s been really positive so far.”