Rutland Regional Medical Center Sole Vermont Hospital Named Blue Distinction Center for Maternity Care

Rutland Regional Medical Center Birthing Center Staff

This past January Rutland Regional Medical Center was named a Blue Distinction Center for Maternity Care for their steady work to improve maternal health outcomes.

Rutland, Vermont — Improving quality of care for birthing people has been a laser focus for Rutland Regional Medical Center’s (RRMC) Women and Children’s Unit and Birthing Center. This past January, the steady work to improve maternal health outcomes paid off when the hospital was formally named a Blue Distinction Center for Maternity Care—the only hospital in Vermont to receive this distinction. This award is for exceptional care demonstrated through specific measurable outcomes at facilities that meaningfully differentiate the delivery of care.

On a recent sunny June day, Leah Romine, Nurse Director of the Women’s and Children’s Unit and Birthing Center at RRMC spoke about the program’s steady growth in quality outcomes and her hopes for maternal health across the state.

She issued a challenge: that every birthing program across Vermont close the gaps in maternal care outcomes and attain the Blue Distinction Center designation.  

Rutland Regional’s care outcomes are “a great lesson for statewide conversations at other health care facilities. There's a lot to learn here; our goal is to raise the bar for all Vermonters,” said Romine.

To be named a Blue Distinction Center for Maternity Care by Blue Cross and Blue Shield of Vermont, Rutland Regional put in place various evidence-based trainings and procedures to reduce traumatic births, severe maternal morbidity events, and cesarean sections. This work is critical. National statistics are alarming: Black patients have a 46% higher probability of delivery complications than White patients, while Asian/Pacific Islander patients have the highest rates of gestational diabetes (14.8%). Surprisingly, one third of severe maternal morbidity events happen in the first six weeks postpartum, with events disproportionally impact Black patients. Blue Distinction Centers set metrics for the hospital or birthing center to build programs and trainings to close these gaps in clinical care.  

Romine explained how the RRMC care team has systematized the delivery of clear and understandable information, so new parents go home knowing what the warning signs are and when to seek follow up care, ensuring the information is given in the language that the patient is most comfortable communicating in.

With 26 years of experience as a labor and delivery nurse working in hospitals in Los Angeles before joining Rutland Regional, Romine applied her experience to the task of earning this distinction. She is passionate about the challenges and opportunities facing birthing people in Vermont and is realistic about reaching for quality improvements. Together with her team, she has shown the Rutland community that intention and dedication can lead to positive change.  

There are a number of criteria that must be met in order to be awarded the Blue Distinction Center for Maternity Care, including that the facility has an internal quality improvement program; uses a standardized obstetric hemorrhage emergency management plan; uses standardized protocols for management and treatment of key severe maternal morbidity events (severe hypertension, eclampsia, seizure prophylaxis, and magnesium overdosage, as well as postpartum hypertension and preeclampsia); and safely reduces the number of cesarean section births. This effort is combined with other factors that include regular emergency drills and preventative measures.

The focus on quality improvement at Rutland Regional is remarkable. Over the past four years, RRMC’s Women and Children’s Unit and Birthing Center has decrease cesarean and episiotomy rates, decreased obstetric complications, and increased breastfeeding rates. Last year, the hospital also expanded their care team to include midwifery.

This didn’t happen by chance. Working with Blue Cross VT’s quality metrics, RRMC’s Birthing Center set goals across their entire team to systematically improve the health outcomes of babies and birthing patients. They took the feedback from their initial application, worked on the gaps, and then reapplied. The Blue Distinction affirms the measurable results of their efforts.

“People struggle with change. So, when you have a complex organization with many different people moving in many different directions, it takes a lot of intention for a change agent to implement something.”

For a complex organization to implement changes that result in demonstrable quality improvement, data and learning from best practices are both key. The year before Romine was named the Director of the Women and Children’s Unit, the team applied for the Blue Distinction designation and didn’t get it. They looked at the data and dug into innovative practices and policies nationally.  

The real time data exchange helps to incentivize a little friendly competition and the entire team takes pride in improving their rates.

“If we don't know how many first-time moms are having C-sections, and why they're having those C-sections, how can we change what we're doing? So, to think about this as a learning opportunity for other hospitals, you can look at something like C-section data and move the needle.”

There are supportive perinatal quality collaboratives that have published toolkits, such as the California Quality Maternal Care Collaborative or the Northern New England Perinatal Quality Improvement Network, a program from Dartmouth Health. Also, reviewing charts monthly in provider committee meetings through Vermont Child Health Improvement Program and attending quality conferences builds collaborative support across facilities which can improve outcomes.

“It’s really a collaborative open sharing environment. It’s so nice to connect to peers outside of the confines of each hospital. There's no reason to reinvent the wheel.”

Another strategy for change is finding an ambassador in each service area.

“You get their buy-in by getting support from a champion, whether it's another nurse or an obstetric doctor, or a midwife, and then you bring in other people and eventually you have a great program. Change is hard. You need these ambassadors because if you go in as a leader and say, ‘we're going to do this change,’ people are going to resist and it's not going to get done. So, you can't just dive right in. You have to go at it in a roundabout way and engage everybody as a team.”

When you ask Leah Romine what her next goal is, it’s to raise the bar across the whole state.

“Let’s look at the statewide average—wouldn't it be great to have a goal? Healthy Vermonters everywhere! I'd love to see everybody get awarded the Blue Distinction for Maternity Care too. One down – 13 to go.”