98 | SEPTEMBER 26 • 2019
Huron Valley-Sinai Hospital works to
enhance childbirth safety with fewer
caesarean sections.
SHARI S. COHEN CONTRIBUTING WRITER
Health
C
aesarean 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 tra-
ditional vaginal delivery. The
national C-section rate is 32
percent, with Michigan only
slightly lower at 31.9 percent.
While sometimes neces-
sary for the mother or baby’
s
health, obstetricians are con-
cerned 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 gynecolo-
gy 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 preg-
nancies. This potentially impacts
the baby, he says, because “get-
ting squeezed out during a vag-
inal delivery results in compres-
sion 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 breath-
ing problems, infections and
embolism, resulting in a higher
morbidity rate, says Chaur-
Dong Hsu, M.D., M.P
.H., spe-
cialist-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 vag-
inal birth after a caesarean.
CHANGING PERSPECTIVE
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 moth-
ers from being fully admitted
and then frustration sets in
and then people start doing
something, such as breaking the
mother’
s water or administer-
ing 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 chanc-
es 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 spe-
cialist 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 import-
ant 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 prena-
tal classes include information
about what can be expected of
labor, options to reduce pain
and the efforts to reduce
unnecessary cesareans.
Clinical Nurse Specialist Madonna
Ladouceur with Dr. Danny Benjamin
A pregnant mom uses
the meditation music
station on the indoor
activity path at Huron
Valley-Sinai Hospital.
New
Initiatives