A summer optimizing obstetrics health care

Second-year student Antoilyn Nguyen spent their summer as a researcher analyzing labor and delivery charts as part of a long-term cohort study to standardize labor induction for better and more equitable results.

Antoilyn Nguyen
Second-year student Antoilyn Nguyen is pursuing a bachelor’s degree in gender, sexuality, and women’s studies in the College of Arts and Sciences.

Over the years, multiple studies have demonstrated racial disparities in labor and delivery outcomes, but few interventions have addressed them. This summer, Antoilyn Nguyen, a second-year student in the College of Arts and Sciences from Santa Ana, California, contributed to a cohort study that does just that. Working with Rebecca Hamm, an assistant professor of obstetrics and gynecology at the Perelman School of Medicine, Nguyen spent the summer as a Penn Undergraduate Research Mentoring Program (PURM) participant, a program administered by the Center for Undergraduate Research & Fellowships, reviewing patient charts at the Hospital of the University of Pennsylvania (HUP) for a study of newly standardized induction protocols.

Beginning in 2019, Hamm began analyzing data from an earlier patient study as a framework to design induction practices with the goal of reducing cesarean rates and reducing racial disparities in neonatal and maternal deaths. Hamm’s study combines both patient satisfaction surveys and provider acceptability surveys for standardized induction practices.

Nguyen spent their days reviewing HUP and Pennsylvania Hospital patient charts, and spent two days in person on labor and delivery floors, getting a firsthand experience putting the procedure into practice. They are pursuing a major in Gender, Sexuality, and Women’s Studies. “I have an affinity for Dr. Hamm’s research because it investigates real interventions that can change long-standing medical guidelines and practices within the system of health care,” says Nguyen. “I find it meaningful to work on research that takes direct action in systemic change.”

Nguyen spent several hours a day reviewing patient charts—there are 7,000 to review for the study. “I read the progress notes left by those that were present throughout their labor and input this information into a HIPAA-compliant system, RedCap. I reviewed information such as their cervical dilation throughout labor, the time it takes between different actions to induce labor, and postpartum conditions,” Nguyen says. “This chart extraction and data analysis allows us to complete several statistical analysis tests to analyze the protocols.”

Rebecca Hamm.
Rebecca Hamm is an assistant professor of maternal fetal medicine at Penn Medicine. 

“Antoilyn is amazing,” says Hamm. “They are doing chart reviews of patients who qualify for the pre- and post-induction group, data analysis, and spent two days on the labor and delivery floor. For an undergraduate with no prior birth experience, this really gave Antoilyn a sense of what we are actually working on.”

“As I was reviewing the charts, I realized how different each person’s labor journey is. Some people who are induced enter active labor quickly, while others take much longer. I now understand why the delivery of a newborn is so unpredictable,” Nguyen says.

“I also found myself immersed in each patient’s labor journey. This actually hindered my productivity at times because I would be so invested that I would review information not needed for the research. Part of me deep down was always praying that they would be OK, or if the patient is OK now. I didn’t realize that I would be so invested in each patient’s story and history.”

The research team just finished a physician qualitative component, and are working on patient qualitative results. “Many of the patients we saw expressed feelings of doubt, stress, or fear about their pregnancy or baby, but Dr. Hamm and others on the labor floor always did their best to reassure patients by providing words of comfort and answering all questions transparently and truthfully. I have never seen this kind of sympathy and kindness in health care before, so it made me happy. It reaffirmed the belief in my head that you can’t be a good doctor if you do not have understanding and compassion.”

Across the U.S., the process of inducing labor has never been standardized, varying from state to state and even from hospital to hospital. The subjective nature of induction has led to varying rates of cesarean sections, quality of care, and even maternal and neonatal mortality rates based on race. Interventions are needed to reduce the national primary cesarean rate, and innovations can reduce racial disparities in obstetrics. Labor induction practices make up 20% of deliveries in the U.S., and the protocols for inducing labor vary more significantly than spontaneous labor management. The ultimate goal of this study is to standardize labor induction protocols in a way that benefits both patient and practitioner. Doing both qualitative and quantitative data analysis means that practices are streamlined for better outcomes, healthier patients and newborns, and satisfied doctors. “We all need to be adaptable,” Hamm says.

By standardizing care using data from successful trials, a significant reduction was found in neonatal morbidity for Black patients using the induction protocols, along with a reduction in the racial disparity in cesarean delivery rates. The goal Hamm and her team set was a reduction from a 33% cesarean rate for patients undergoing labor induction to 28%. This work has the potential to support the well-being of pregnant people across the country, by tailoring a national implementation plan to best affect labor and delivery outcomes.

“I knew that things were always moving fast on the labor and delivery floor, so that did not surprise me. But I underestimated the amount of consultation that went into a patient’s plan of care. The team was always discussing and talking to each other about what the next best steps were in caring for a patient,” Nguyen says. “I know it seems obvious, but I did not realize how much confirmation and discussion (between the health care team) happened outside a patient’s room because I was always used to being the patient and not the medical provider.” Now, with the work they did this summer, Nguyen has had a hand in streamlining that care for best, and more equitable, results.