Annie West began bleeding internally after an emergency Cesarean section.

West, who had just delivered twins, says she might have panicked if she weren't confident in the doctors and nurses caring for her at Aurora Women's Pavilion in West Allis, Wis.

"They were so seamless," says West, 31, who says she and her twins, born April 1, are doing well. "They obviously had it all under control."

West's doctors and nurses regularly rehearse how to handle critical situations, says Claudette Hamm, regional director of women's health at Aurora Health Care. The hospital is one of 16 leading a new effort, officially launched today, to reduce birth injuries, says Susan DeVore, chief operating officer of the Premier Inc., a health care alliance that promotes hospital safety and quality and is coordinating the 21-month campaign.

About three infants out of every 1,000 delivered are injured during birth. Nearly 80 percent of those injuries might be preventable, DeVore says. While some problems are minor, others can cause paralysis.

Research shows that most injuries stem from five central problems: failing to recognize when a baby is in distress; failing to perform a C-section in time; failing to properly resuscitate a baby; using drugs to induce labor inappropriately; and using a vacuum or forceps inappropriately, according to Premier.

The 16 hospitals (a list is available at www.premierinc.com; all are on the Mainland) have committed to following a set of guidelines that are proven to reduce harm in each of these situations, Devore says. The recommendations work best when teams consistently perform every step, she says.

When using drugs to jump-start labor, for example, teams should make sure the baby is full term, monitor its heart rate, check the baby's position and the condition of the uterus, and watch for danger signs that the uterus has become "hyperstimulated," clamping down on the baby's head and reducing oxygen flow, says Kathy Connolly, a nurse and project team leader at Premier.

"We want everyone to know what it is they are to do, so the patient doesn't perceive it as anything other than routine," Hamm says.

At Harris Methodist Forth Worth Hospital, doctors and nurses run drills on computerized simulators named "Mama Noelle" and "Baby Hal." The simulators let them practice delivering a baby whose shoulder is stuck, for example.

Teams also will take time to develop clear plans, Connolly says. Before using a vacuum device to deliver a baby, for instance, doctors and nurses should agree on how many attempts to make and when to switch to a C-section. Taking the time to develop such strategies can be costly. But DeVore says hospitals in the program believe their investment will pay for itself by reducing expenses and avoiding costly lawsuits.

Connolly says the hospitals in the program expect to deliver 115,000 babies before the initiative ends. "We want to eliminate all preventable injuries to those babies," she says.