Project Summary

The Improving Safety, Patient Experience, and Equity through Shared Decision-Making Huddles in Labor (I’M SPEAKING) proposal was developed after the study team listened to patients who had given birth in Illinois. Some patients expressed that they did not feel that they were listened to when they had their babies, or that they did not want or did not understand the care that they received. Patients expressed that they did not take part in the decisions about their own labor or birth. This happened more commonly among Black patients.

Black patients who have babies in Illinois and elsewhere in the United States experience more complications during and around childbirth and more frequently die from these complications. Black patients are also more likely to experience cesarean birth, and cesarean birth can put people at increased risk for life-threatening complications. It is important to safely reduce cesarean births to improve care for patients having babies and to center this work on the needs of Black birthing patients. 

Cesarean birth often happens because of a decision that is made during labor. Sometimes that decision is made only by doctors and nurses, and patients can feel the decision was made for them and not with them. Patients who have had life-threatening complications around childbirth often say that they were not included in decisions around their care, or that doctors or nurses did not listen to them. 

The I’M SPEAKING proposal aims to find a way to change these experiences. TeamBirth is an initiative that trains hospital teams to better listen to patients during their labor, to understand the needs and preferences of each patient and to make decisions with the patient – shared decision making. 

TeamBirth trains hospital teams to have regular “huddles” with providers and the patient throughout the labor process and to write down on a whiteboard what the patient wants and what decisions have been made with each huddle. 

The first step of the I’M SPEAKING proposal (Aim 1) is to modify all TeamBirth materials to make sure that they meet the needs of Black birthing patients. The study team will do this through a process called human-centered participatory design whereby they will work with a group of obstetric providers and another group of Black patients who have recently given birth. By partnering with these groups, the study team will learn what is important to change, and then work with a team of graphic designers to adapt TeamBirth materials appropriately.

In the next step (Aim 2), the study team will use a srandomized stepped-wedge study design to learn if using TeamBirth across 22 hospitals in Illinois can reduce cesarean birth, particularly for Black birthing patients. The study team will learn if using TeamBirth can improve patient experiences of respectful care and shared decision making. They will also learn if TeamBirth can improve hospital culture to be more supportive of vaginal birth. All 22 hospitals are part of the Illinois Perinatal Quality Collaborative (ILPQC), an organization that helps hospitals improve care of pregnant patients across the state. The study team has partnered with ILPQC to accomplish this aim. Hospital teams are ready to work on this initiative; they already have people and processes in place to start TeamBirth and to collect all of the data needed to succeed. 

Finally (Aim 3), the team will study how well TeamBirth has been implemented. They have picked four diverse hospitals where they will talk to patients and providers and observe whether and how often TeamBirth huddles are performed during labor. After all 22 hospitals have launched Teambirth, the study team will pick four more hospitals to further study the implementation of TeamBirth. They will pick the two hospitals who have achieved the highest level of shared decision making and the two with the lowest, and interview hospital staff and patients in these hospitals to understand these differences.

Throughout, patient input will guide this work with quarterly patient and community advisory meetings and patient partners on the research team. The team will summarize their findings for patients and hospitals who participated and create a toolkit so that other organizations, such as state perinatal quality collaboratives, can readily adopt the most successful implementation strategies, improve the care of birthing persons, increase shared decision making and safely decrease cesarean birth, especially for Black birthing persons.

Project Information

Ann Borders, M.D., MPH, MSc
Beth Plunkett, M.D. MPH
NorthShore University HealthSystem
$7,065,426 *

Key Dates

60 months *
April 2024

*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.


Project Status
Award Type
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: April 23, 2024