For the first few cases, the Perinatal CNS remained in the OR and assisted the nursery nurse in positioning the infant. We then offered in-service education to the nursing staff and pediatric residents and posted a bulletin board presentation in the birth center and the nursery that was visible to both staff and patients. We also distributed the flowchart (Figure1) to the staff and posted it in the OR. At this point, we encouraged all staff members to participate in implementing the intervention, and continued collecting data to monitor our improvement. We kept staff up-to-date on our progress by posting result data and patient feedback.