Huron Valley-Sinai Hospital works to enhance childbirth safety with fewer caesarean sections.
Photos courtesy of DMC Huron Valley-Sinai Hospital
Caesarean sections, a surgical method to deliver babies, were once somewhat rare. Today, however, seemingly everyone knows someone who has had a C-section rather than a traditional vaginal delivery. The national C-section rate is 32 percent, with Michigan only slightly lower at 31.9 percent.
While sometimes necessary for the mother or baby’s health, obstetricians are concerned about the increases in C-sections because they pose some risks and disadvantages versus non-surgical deliveries. Efforts are under way nationally and locally to reduce the use of C-sections.
Danny Benjamin, M.D., chief of obstetrics and gynecology at DMC Huron Valley-Sinai Hospital in Commerce, explains that mothers who have one C-section may then be subjected to caesareans for all future pregnancies. This potentially impacts the baby, he says, because “getting squeezed out during a vaginal delivery results in compression that reduces fluids from the lungs.” C-sections eliminate that process and babies often require incubation as a result, delaying important early mother-baby interaction.
For mothers, C-sections increase the risks of breathing problems, infections and embolism, resulting in a higher morbidity rate, says Chaur-Dong Hsu, M.D., M.P.H., specialist-in-chief of ob/gyn at the Detroit Medical Center (DMC) and chair of the department of obstetrics and gynecology at Wayne State University.
Approximately 6,000 babies are delivered at the DMC’s Hutzel, Sinai-Grace and Huron Valley-Sinai hospitals annually, and the C-section rates vary considerably. Benjamin says Huron Valley-Sinai Hospital’s C-section rate is 13 to 17 percent, the lowest within the DMC. “We want to create a structure to bring them all into a normal range,” he says.
Hsu attributes the rise in caesareans to an increase in patients’ obesity, large babies and more twins. Also, some mothers don’t want to try a vaginal birth after a caesarean.
The DMC’s goal is to reduce caesareans for uncomplicated first pregnancies and Huron Valley-Sinai is leading the effort.
“Maybe the decision to have a C-section is made a little early,” Benjamin says. In the past, women whose cervixes were dilated only 1-2 centimeters were considered in labor and could be admitted. Now, active labor is defined at a later stage by the American College of Obstetricians and Gynecologists.
“We are trying to keep mothers from being fully admitted and then frustration sets in and then people start doing something, such as breaking the mother’s water or administering Pitocin (a drug to induce or speed up labor),” Benjamin explains.
During the early stages of labor, he says, “We are using comfort measures and keeping mothers mobile.” Studies show that women active in early labor have a shorter overall labor and better delivery experience. Walking also reduces the chances of a C-section because of less time spent in bed.
The hospital has created an indoor walking path with eight activity stations. “This is ideal for women coming in with early labor,” says Madonna Ladouceur, clinical nurse specialist at the hospital’s Harris Birthing Center. “It can help with pain management and help move the baby into the ideal position, which helps labor progress.”
At each activity station, the mother is encouraged to do a certain exercise or watch a video about medication and lactation. Ladouceur says the walking path has been well-received.
Another new feature at Huron Valley-Sinai Hospital is the use of nitrous oxide to relieve anxiety and pain during labor. It is administered through a mask and can be used with other pain medications.
“It provides a nice relaxation feel and a very minimal amount goes to the placenta,” Ladouceur explains. “It gives mothers a little more tolerance for their labor. A C-section is available, if needed.”
C-sections often result when the baby is believed to be in distress — as indicated typically by a fetal monitor. However, Benjamin says fetal monitoring can result in “false positives” depending on how it is being interpreted. He says it’s important for nurses and physicians to have the same training so that data from fetal monitoring strips are accurately and consistently evaluated.
Huron Valley-Sinai’s prenatal classes include information about what can be expected of labor, options to reduce pain and the efforts to reduce unnecessary cesareans.