Iowa’s statewide rate was projected to climb. One virtual training day across 43 facilities changed the direction.
Perinatal quality collaboratives exist to move population-level outcomes. They bring facilities together, align around evidence-based bundles, and work to close the gap between what the research says and what happens in delivery rooms across an entire state.
What they need to accomplish that goal is perinatal quality collaborative nursing education that informs and inspires clinicians and actually changes practice. Not a webinar nurses forget by the following Tuesday. A training that shifts how nurses understand their role, builds skills they use immediately, and creates the kind of confidence that shows up at the bedside on the next shift.
In 2021, the Iowa Maternal Quality Care Collaborative found out what that looks like.
What a Perinatal Quality Collaborative Needs From Nursing Education
The AIM Safe Reduction of Primary Cesarean Birth Patient Safety Bundle is the national standard for collaborative cesarean reduction work. It calls for facilities to build a culture that values, promotes, and supports spontaneous onset and progress of labor and vaginal birth. The Birth Nurse is cited as Reference 43 in that Change Package, alongside ACOG committee opinions, AWHONN resources, and peer-reviewed clinical research.
That is a culture change ask. And culture does not change through policy documents. It changes when the nurses at the bedside understand why what they do matters, have the skills to act on that understanding, and feel confident enough to reach for the tools available to them.
Peanut balls are one of those tools. Nurse-driven, no order required, physiologically grounded, and immediately applicable to any laboring patient. When nurses understand how positioning affects fetal descent at each station of the pelvis, they do not need to be reminded to use the peanut ball. They reach for it because they understand why it works.
The Iowa Maternal Quality Care Collaborative understood this. They brought in The Birth Nurse to deliver a virtual Peanut Ball Learning Day to staff across all 43 participating facilities as part of their quality improvement initiative. The training was designed to be both a skill-building experience and a trauma-informed care intervention, because the two are inseparable.
Statewide Cesarean Reduction: What the Iowa Collaborative Was Up Against
Iowa’s statewide cesarean rate was on a trajectory to increase by 2% in 2021. The collaborative was grant-funded and working within the AIM framework, with 43 facilities participating in the Safe Reduction of Primary Cesarean Birth bundle. The challenge was not awareness. Facilities knew the goal. The gap was at the bedside, where nurses needed practical skills, a shared framework, and the kind of training that sticks past the day it is delivered.
A second COVID-19 surge made in-person training impossible. The collaborative needed a virtual solution that could deliver real skill transfer across a geographically dispersed group of nurses, at scale, without losing the hands-on quality that makes positioning training work.
The Birth Nurse is cited as Reference 43 in the AIM Safe Reduction of Primary Cesarean Birth Change Package, alongside ACOG committee opinions, AWHONN resources, and peer-reviewed clinical research. The Birth Nurse is referenced for: “Trauma-Informed Healthcare Consulting and Education.”
AIM Safe Reduction of Primary Cesarean Birth Change Package
Peanut Ball Training for Perinatal Collaboratives: What the Training Covered
The Birth Nurse delivered a live virtual Peanut Ball Learning Day to 200 staff across the Iowa collaborative. The training covered peanut ball sizing, contraindications, first and second stage positioning, and the physiologic reasoning that connects each position to fetal station and descent. Nurses worked through clinical scenarios and left with the positioning workbook as a bedside reference.
The training was built on the trauma-informed care framework that The Birth Nurse brings to every program. Nurses not only learned peanut ball basics and care. They also learned how to strategically offer peanut balls in a way that centers patient autonomy, how to have the shared decision-making conversation, and how to make individual adjustments based on each patient and their goals.
That combination is what makes the training align with the AIM bundle’s respectful care requirements. Positioning is the skill. Trauma-informed care is the framework that makes the skill psychologically safe and truly effective.
What L&D Nurses Said After the Training
Nurses came in at every confidence level. Some had been using peanut balls for years but in only one or two positions. Some were newer to OB and building baseline skills. What changed for both groups was the same: the physiology clicked.
“I use the ball a lot, but now I can be more efficient. Knowing the physiology, it all just clicked!”
Dena S, RN, Iowa Collaborative Attendee
“Very basic understanding before this training, putting peanut ball between the knees in bed, that’s it. Much more confident now, a much better understanding of what positions work best for what position baby is in the pelvis.”
MaKayla L, RN BSN, Iowa Collaborative Attendee
“I feel like what I learned about peanut balls previously was just the tip of the iceberg. This was much more comprehensive!”
Kay G, Clinical Nurse Educator, LDRP
That shift from basic skill to physiologic understanding is what changes practice long-term. A nurse who knows where the baby is in the pelvis and why a specific position creates space at that station will be able to teach her patients, families, and colleagues for a much more sustainable practice change than basic skills alone.
The Statewide Cesarean Reduction Results
Iowa’s statewide cesarean rate was projected to increase by 2% in 2021. Alongside the collaborative’s broader quality improvement work, it decreased by 2% instead. That’s a four-point swing at the population level.
These results are huge for all 43 facilities, delivered virtually, all during a COVID-19 surge.
That outcome happens when a quality collaborative makes the right educational investment at the right moment in an implementation cycle, and when nurses leave that training ready to practice differently.
What This Means for Your Perinatal Quality Collaborative or Health System
If your collaborative or health system is working toward AIM safe reduction of primary cesarean goals, the question worth asking is not which protocol to add. It is what your nurses know, what they feel confident doing, and whether your nursing education investment is closing the gap between having the tools and sustainable, strategic practice.
Peanut ball training grounded in trauma-informed care is one of the highest-leverage educational investments available for cesarean reduction work. It targets the exact bedside behavior the AIM bundle is trying to shift. It is hands-on, immediately applicable, and builds the kind of nurse confidence that supports culture change toward a psychologically safe practice – for patients and nurses.
The Birth Nurse offers virtual and in-person Peanut Ball Learning Days for perinatal quality collaboratives, grant-funded maternal health initiatives, and multi-facility health systems. Programs are scalable, AIM-aligned, and designed to move outcomes at whatever level you are working.
Schedule a call to personalize a program for your statewide collaborative.
Is your collaborative or health system working toward AIM cesarean reduction goals?
The Birth Nurse offers statewide and system-level peanut ball and trauma-informed labor support training for perinatal quality collaboratives, grant-funded initiatives, and multi-facility health systems.
