Letting Nature Take Its Course

Low C-Section Rates at Sentara Martha Jefferson Contribute to Healthy Birth Outcomes

Time and again, studies have shown that statistically, low-intervention births offer the best outcomes for expectant mothers and their newborns. At Sentara Martha Jefferson Hospital, striving for a low cesarean section rate helps to ensure that soon-to-be moms have the birth experiences they desire, and that moms and babies stay safe and healthy during the delivery process.

In 2018, C-sections made up just 27 percent of all deliveries at Sentara Martha Jefferson—significantly below the national average of 32 percent in 2017, according to the most recent data from the Centers for Disease Control and Prevention (CDC). The rate of total primary, or first-time, C-sections at Sentara Martha Jefferson was 13 percent in 2018, compared to the national average of 21.9 percent in 2017.

C-sections are the most common surgeries performed at U.S. hospitals, according to the CDC. Vaginal birth, however, is still the safest—and preferred—method of delivery. Women who are able to give birth vaginally tend to experience less pain, reduced risk of infection and faster recoveries. In addition, babies delivered vaginally often can start breastfeeding immediately after birth.

Over the past several years, C-section rates across the United States have gone down due to a national focus on improving maternal mortality rates. Sentara Martha Jefferson is committed to that effort, striving to reserve C-sections only for high-risk pregnancies and medical emergencies.

“Our goal at Sentara Martha Jefferson is always to run below the national average for C-sections, because we know the benefits that low-intervention births bring to mothers and babies,” says Jennifer Wray, MSN, RN, clinical nurse manager of the hospital’s obstetrics unit. “Our providers and nursing staff also are committed to identifying every appropriate nonmedical intervention for each patient, to prevent the need for C-sections whenever possible.”

Preparing for an Ideal Birthing Experience

Sentara Martha Jefferson offers an array of resources and educational opportunities to give moms-to-be with low-risk pregnancies the best chance of avoiding a C-section. As part of those efforts, the hospital offers classes on childbirth, breastfeeding, prenatal yoga and family care; tours of the birthing facility; and guidance to help moms and babies stay healthy during pregnancy.

“We engage patients early in the first trimester, so that hopefully by the time they arrive for their birth experience, they understand we are there to meet their needs during the delivery process,” Wray says. “Participation rates with these opportunities are high, so many of our patients come into their labor and delivery as prepared as they can be. That focus on community preparation has a very positive impact on their overall experience.”

Doctors start conversations with patients about their ideal birthing experience by the second or third trimester, guiding the discussion based on any medical concerns. Whenever possible, they strive to accommodate the patient’s preferences.

“Communication is key,” says Emily Huffstetler, MD, of Jefferson Obstetrics and Gynecology. “Listening to women and educating them during their prenatal care is important. We really want every patient to have the birth experience she wants—and in the end, we just want healthy babies and healthy moms.”

Promoting a Low- Intervention Environment

Sentara Martha Jefferson’s Family Birthing Center offers comfortable birthing rooms that are designed to facilitate low-intervention techniques. Each room is equipped with items to manage pain without medication, including whirlpool tubs, birthing balls and birthing stools. The hospital also recently started offering nitrous oxide as an alternative option for pain relief.

Women are encouraged to move around and walk during labor. For low-risk pregnancies, intermittent monitoring or portable fetal monitors allow them to move about freely. In some cases, special fetal monitoring equipment can be used while the patient labors in a whirlpool tub. Those who choose to have an epidural are directed to change positions frequently.

Women may invite a limited number of care partners, including their spouse or partner and a doula, into the room for support.

“That support and encouragement helps women feel more confident,” Dr. Huffstetler says.

One of the primary factors in helping to reduce the C-section rate at Sentara Martha Jefferson involves the hospital’s medical team. Caregivers emphasize the importance of allowing adequate time for labor to progress naturally before making decisions about interventions.

“We strive to be patient with the delivery process and promote a vaginal delivery whenever possible,” Dr. Huffstetler adds. “As long as the baby is tolerating labor and the mom is safe, there’s no need to hurry the process along.”

Wray adds that helping women achieve their ideal birth experience aligns well with Sentara Martha Jefferson’s Caring Tradition.

“Our commitment to the Caring Tradition and high-quality care is a huge part of why we offer numerous options for women to have a low-intervention birth experience,” Wray says. “By maintaining a low C-section rate, we are able to be leaders within the Sentara Healthcare system, as well as throughout Virginia and nationally. We want to consistently outperform national standards, so that we can help bring about the best outcomes for our moms and their babies.”

Transforming the C-Section Experience

There are times when a vaginal birth isn’t possible and a cesarean section is medically necessary. For women who need to undergo the procedure, Sentara Martha Jefferson Hospital offers the “gentle C-section”—a patient-centered experience that strives to make birthing in the operating room as similar as possible to what occurs in a traditional labor and delivery room.

A distinctive feature of the gentle C-section at Sentara Martha Jefferson is the “clear drape,” which the patient can request. Although similar to the blue surgical drapes used in other procedures, the clear drape has a sterile, clear portion through which the mother can watch her baby being born, facilitating a more natural-feeling cesarean delivery. The surgeon simply lets down the colored section of the drape seconds before pulling the baby out of the mother’s uterus. Once the baby has been delivered, the colored section of the drape is put back up while the surgeon completes the procedure.

Many other elements also help make the gentle C-section a positive experience for patients and their partners. Soft lighting and calming music (of the patient’s choice) in the operating room promote a relaxed mood. The anesthesiologist can place cardiac monitors on the side of the mother’s chest to allow the baby to snuggle in close for immediate skin-to-skin time after birth—this enhances mother-baby bonding and promotes success in breastfeeding, which can be initiated during the precious moments right after birth. The obstetrician also can delay cord clamping, which can help reduce newborn anemia.

“We are able to bring a unique experience to the C-section patient,” says Jennifer Wray, MSN, RN, clinical nurse manager of the hospital’s obstetrics unit. “We are leaders with regard to facilitating skin-to-skin contact for moms and babies in the operating room, as well as with the total gentle C-section experience. Even though having surgery isn’t always ideal, the gentle C-section allows moms to be more engaged in the process.”

By the Numbers

Comparative percentages of all deliveries that use C-sections:

Sentara Martha Jefferson (2018): 27%

Sentara Martha Jefferson (2017): 27%

Nationally (2017): 32%*

Throughout Virginia (2017): 32.6%*

* Source: Centers for Disease Control and Prevention

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