The daily Astorian. (Astoria, Or.) 1961-current, July 23, 2015, Image 4

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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-
‘At the
proach to pregnant
Childress said
“At the end of the day, we
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
a hospital setting, the entire team with an eye on
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
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 —
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.
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
When considering safe and
appropriate opportunities to pre-
vent overuse of cesarean deliv-
eries, sources suggested several
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
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-
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
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
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