The following New York Times article, “One Hospital’s Plan to Reduce C-Sections: Communicate” highlights several areas where changes at the individual hospital level may be effective in lowering the C-section rate:
- Involving patients in decision making using supportive care.
- Using a white board to write down birthing team member names and the individual family birthing preferences to assure patient’s preferences are communicated.
- Use of a modified standard labor curve to define labor progress.
Cesarean section rates are too high in the country and have been increasing for many years. For some women, with rare conditions and for high-risk labor, C-section can be lifesaving. Still, a cesarean operation carries a high risk for infection, hemorrhaging, and even death and should be avoided if vaginal birth can be safely accomplished. The development of too many C-sections is primarily attributed to several overarching misconceptions about C-section and outdated and ineffective theory for when a C-section is necessary.
Many providers and hospitals still adhere to the Friedman Curve, a study that became the gold standard for when to perform a C-section, established in 1955 by the obstetrician, Emanuel Friedman. Providers and hospitals that use the newest, best evidence-based practices have discarded the Friedman Curve as outdated, for which determined that labor began sooner (4 centimeters dilated vs. 6 centimeters) and took less time (1-centimeter dilation per hour vs 3 centimeters) than it actually does for women today. There are two primary reasons why C-sections are performed, “arrest of labor,” meaning the labor is stalled or “unreassuring fetal heart tones,” which is an alert to how well the baby is tolerating labor. The bottom line is, providers should modify to allow proper time for women to progress before assuming “arrest or labor” or “unreassuring fetal heart tones” and rushing to C-section.
Here at North Suburban Medical Center and throughout the entire Women’s Health Group practices, we are proud to report that we are using the newest, best evidence-based techniques to achieve high-quality outcomes and low C-section rates for our patients.
Here are some of the ways we achieve our goals:
1.) Labor nurses work in teams to give great care and make sure patients are well attended.
2.) We staff our hospitals with an on-call provider who is responsible all day so there is no rush ever to do a C-section for convenience.
3.) We have on-site anesthesia and neonatal nurse practitioners who attend all deliveries when needed. When we do need to do a C-section, it can be done immediately and with the entire team already present. Not every hospital system supports that kind of system.
4.) We have a white board in every room where we write down all the information for patients to feel validated and included. They always know who to communicate with.
5.) We are patient with labor; we follow the latest guidelines and are sensitive to individual variation in labor patterns. We give our patients the time they need to have the best chance for a natural childbirth experience.
What does that result in? We receive great results in outcomes with very low C-section rates.
Our Primary C-Section Rate (2018): 13.3% National average (2012): 17.4%. We are 24% less likely to do a C-section.
Our Total C-Section Rate (2018): 22.7% National average (2012): 32.9%. We are 31% less likely to do a C-section.