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New faculty: Neal will train next generation of nurse-midwives

Oct. 13, 2014, 4:11 PM

Jeremy Neal, assistant professor of nursing
Jeremy Neal, assistant professor of nursing (Susan Urmy/Vanderbilt)

Cesarean delivery is the most common major surgery in the United States. Although it is sometimes necessary for the health of a mother or her baby, Jeremy Neal thinks too many C-sections are done without good rationale, contributing to adverse health outcomes.

“It’s an ongoing national priority to safely decrease cesarean rates, particularly among low-risk, first-time mothers,” said Neal, who joined the School of Nursing as an assistant professor this fall. Since nine out of 10 women with a cesarean will have the surgery again in future pregnancies, reducing C-sections for first-time moms is the most effective method.

“The wide variation in cesarean rates among hospitals is almost entirely explained by differences in rates for first-time mothers. Herein lies opportunity for dramatic improvement in labor care,” said Neal, who was drawn to nurse-midwifery for its philosophy of care. “Nurse-midwives let normal processes progress without unnecessary intervention.”

At Vanderbilt, he will advance his research and teach the next generation of nurse-midwives. A native of Ohio and former U.S. Air Force captain, Neal moved with his wife and four children—yes, he “caught” three of his own kids—to Nashville this summer. He has developed an evidence-based version of the partograph, an instrument that provides a graphical representation of labor, to measure the progression of active labor in first-time moms.

“Pregnant women usually come to the hospital when they think they are in active labor, but once admitted, providers vary widely in how they define ‘slow progress.’ As a result, slow progress in labor is commonly overdiagnosed, which is a true clinical concern,” Neal said. “It’s why half of new moms receive drugs to speed up their labor, and it’s the leading reason why cesareans are performed in these women.”

Neal and his team have just wrapped a pilot study. “Like a pediatrician’s growth chart, our approach is similar in that providers can graph a woman’s labor progress and see how it compares to the latest scientific data,” Neal said. “This way, the provider and mom can graphically visualize and discuss her progress together, allowing opportunity for shared decision making regarding the plan of care.”

Neal’s next step is developing a computerized version of the progression chart.

“We are at a point in our nation where over-intervention in the normal processes of labor and birth may be contributing more harm than good,” he said. “Our team at Vanderbilt will build on existing strengths in the way we provide maternity care to further improve birth outcomes and safety in ways that can be successfully replicated elsewhere.”

View the complete list of new university faculty for 2014-15.

View the complete list of new medical faculty for 2014.

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