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4A THE DAILY ASTORIAN • THURSDAY, JULY 23, 2015 C-sections: ‘We want women to feel like they’re heard’ Continued from Page 1A to the following absolute and non-absolute risk criteria.” If the mother or baby presents with any absolute risk crite- ria, they are precluded from out-of-hospital births and midwives have to transfer care to a licensed physician. Throughout her years of ex- perience, Childress has success- fully conducted vaginal, home- birth deliveries for a majority of her patients, which mirrors national statistics. In a study of roughly 17,000 women conducted from 2004- 09, published January 2014, the Midwives Alliance of North America found that for planned home births with a midwife in attendance: The rate of normal physiologic birth was more than 93 percent; the cesarean rate was 5.2 percent; 87 percent of Surgeons performing a cesarean section. women with a previous cesarean delivered their newborns vag- business broaden the de¿nition though. It is rare for a midwife inally; and of the 10.9 percent to include other “versions of to be sued, Childress said, part- of women who transferred to a normal,” said Priscilla Fairall, a ly because the practice relies hospital during labor, the major- local doula or nonmedical birth on relationship-building and in- ity changed locations for none- companion. formed choice. mergent reasons. Also, the study Childress believes the cost When to intervene found a very low rate of inter- for midwife care is less than What she and Mendoza fear one would pay for hospital care, ventions without an increased is happening at the hospital lev- because there are not the accom- risk to mothers and babies. Besides the fact midwives el is the institutions have started panying hospital charges, which are dealing with more low-risk relying on early interventions, appear to escalate the cost of patients than hospitals — which which sometimes lead to a cas- birth. signi¿cantly complicates direct cade of further interventions. Community Outreach Man- comparisons — trends also ex- Childress agreed that can be ager Paul Mitchell said Colum- ist within the practice that could problematic. bia Memorial is interested in contribute to fewer midwives’ “You start one intervention, reducing the C-section rate and patients needing C-sections. A and they just lead to one right “they routinely evaluate cases lot of midwives after the other,” she and look for improvement op- take a different ap- said. portunities.” ‘At the proach to pregnant Childress said “At the end of the day, we patients. end of the she believes med- would like to have all vaginal With fewer pa- ical professionals deliveries, as it is best for the day, we can avoid problems mother and baby,” he said. “We tients — Childress estimates she will “by understanding weigh all of this with how best have about a dozen would like how birth works.” to provide a safe delivery for the this year — they of- advocates pa- individual mother.” to have She ten can spend more tience and encour- Prior to delivery, obstetri- time with expect- all vaginal ages women to do cians, pediatricians and nursing ing mothers during most of their labor staff review individual cases, prenatal visits. The deliveries, at home where they Mitchell said. When a patient focus of prenatal can rest, because is admitted to the hospital, her as it is care is education, once they are in risk factors “are evaluated by Childress said, a hospital setting, the entire team with an eye on best adding, “We really “it’s often hard to both the mother’s and the baby’s focus on informed relax in that situa- well-being,” he added. for the choice rather than tion,” she said. As for interventions, the mother informed consent” Mendoza feels hospital tries to use integrated by presenting “pa- many things could therapies, such as aromatherapy, tients with a whole and baby.’ be improved at massage and guided imagery, to range of options.” the local hospitals medical interventions. Paul Mitchell when it comes to minimize “We realize that — They also encourage walking community outreach spending time in manager for Columbia infant deliveries. and provide a labor tub, he said. the prenatal period “All the hospital “Our providers, nurses and Memorial Hospital really assists in the births I’ve gone to all other hospital staff are com- end result,” she said. have not been great,” Mendoza mitted to providing care in line During labor and delivery, said. “The celebration has not with CMH’s Planetree philoso- midwives are protective of their been there.” phy, which boils down to pro- patients and try to create a safe Melissa Van Horn, who had viding care that supports the place for them, Childress said. her only child at Columbia Me- whole person,” Mitchell said. Doing so helps the women’s morial several years ago and ex- “Many of our returning moth- own hormones guide the pro- perienced severe complications, ers will request, by name, to be cess, which can lead to the need said “sterile” is the word she cared for by a nurse that they for fewer external interventions. would use. connected with during a previ- Not to say midwives don’t “There’s a lack of emotion, ous birth.” use interventions, but they tend a lack of connection,” she said. Viable solutions? toward natural strategies. “Wa- “It’s all about being pushed While childbirth in general ter is our home-birth epidural,” through the process — that’s poses potential risks to moth- Childress said. That is partly how it felt.” because midwives are limited in However, that could be ers and babies, regardless of what they can do medically, but because “hospitals are in the the delivery method, the rapid also because of the profession’s business of practicing medi- C-section rate increase without dominant philosophy that birth cine,” not recognizing birth for evidence of direct causes “raises is a natural process, not a med- the “incredible experience” it signi¿cant concern that cesarean ical procedure. is, Mendoza said. That’s where delivery is overused,” states a With midwives, birth “is midwives and doulas can add research paper by the American treated like the most natural something different to the birth- Congress of Obstetricians and thing in the world, because it is,” ing business. Gynecologists and the Society Seaside doula Katie Mendoza Not all insurances will cov- for Maternal-Fetal Medicine. said. The trouble is, there is not er midwife care or home-births; Rather than ascribing to a sometimes they are considered the research to “tease out which strict set of guidelines about “out of network” so payments ones really meet the threshold what is normal for a birth, which will be higher. Certi¿ed profes- of risk versus bene¿ts,” said makes deviations seem alarm- sional midwives are not required Dr. Aaron Caughey, who is ing, many in the home-birth to carry liability insurance, chairman of the department of Thinkstock photos obstetrics and gynecology and associate dean for women’s health research and policy at the Oregon Health and Science University. When considering safe and appropriate opportunities to pre- vent overuse of cesarean deliv- eries, sources suggested several methods. While it would not lower the primary cesarean rate, which is most important, increasing lo- cal access to vaginal births after C-sections (VBAC) for appro- priate patients could help break the cycle often created after a primary C-section. Up until a few years ago, CMH and Providence Seaside Hospital had physicians who would conduct VBAC, but the hospitals both changed their policies. Providence’s decision was driven by the potential risks associated with such births and the limited resources of a small community hospital, McCoy said. Among suitable candidates for VBAC, approximately 60 to 80 percent will have a success- ful vaginal delivery, according to the OB-GYN group. The other 20 to 40 percent will end up needing another C-section, so the congress rec- ommends hospitals have an an- Jennifer Childress Priscilla Fairall esthesiologist and obstetrician who can do surgery in the hos- pital at all times. For small, rural hospitals that are under-resourced, having a team available in case a VBAC attempt turns into an emergency situation is sometimes not a via- ble option, especially with other hospitals an hour or two away, Caughey said. Childress, and often other midwives, can conduct VBACs depending on patient risk as- sessment. method for testing a newborn’s health. The results were best when the continuous care pro- viders were neither part of hos- pital staff nor in the women’s social network. Group coordinated care also is a practice that’s been adopted by certain institutions, such as the Oregon Health & Science University’s Center for Wom- en’s Health. Under that model, the prenatal care of women who share a similar due date is pro- vided through discussion and support groups led by a midwife and nurse-midwife. Each of about seven sessions lasts nearly two hours. Not only do group sessions help relieve some of the respon- sibility for prenatal care and ed- ucation from physicians, who have numerous patients to see, but it creates an environment where multiple women and their partners feel free to ask ques- tions and learn from one anoth- er, Mendoza said. Women need to feel like they had input and a choice during every step of the way, she said. “We want women to feel like they’re heard,” and that birth didn’t “just happen” to them, she said. Fairall agreed, adding, “a better birth outcome is not nec- essarily not having a cesarean.” Rather, a good outcome, she said, is when “you’re an active part of your health care.” For de- liveries that require C-sections, she said, women should “feel they can embrace having had a cesarean because they knew what was going on.” Doula support The use of doulas before and during the birth process seems to have positive bene¿ts, as well. Doulas are individuals who offer emotional and men- tal support to women — and their partners — during birth. They are not medically trained, but “having someone by your side, who’s an advocate for the mom during the birth process” can be a great option, Childress said. Using doulas in hospital set- tings has produced some posi- tive results. In a research paper by Dr. Ellen Hodnett and others in the Cochrane Database of System- atic Reviews in 2013, 22 trials involving 15,288 patients re- vealed women given continuous support — such as that provided by a doula — were more likely to have a spontaneous vaginal birth; their labors were short- er; and they were less likely to have a C-section or instrumen- tal vaginal birth or a baby with a low Apgar score, the standard You name it, we’ve banked it. Experience is our strong suit. We’ve been the bank of choice for every kind of business from tech to timber, and everything in between. 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