Cesarean births (C-sections) are an increasingly common birth method in the United States. During this major surgery, an incision is made to the abdomen and the uterus to deliver the baby. While there are some circumstances that warrant the procedure in order to save the lives of moms and babies, the number of elective C-sections has become so common that several medical organizations, like the American College of Obstetricians and Gynecologist (ACOG) and the federal government, have commented on the need to reduce them.
The current goal is for no more than 23.9 percent of first-time, low-risk mothers to deliver by C-section. However, in 2016, the US average was 25.7 percent.
According to the ACOG, C-sections come with an increased risk compared to vaginal births. Some of these risks include: longer healing time and an increased risk of infections, blood loss, blood clots, and injuries to the bowels or bladder.
After two women died post-Cesarean at South Shore Hospital in Weymouth, Massachusetts in 2013, despite the investigation finding no evidence of substandard care, the hospital decided it was time to do something different. And so was born Dr. Neel Shah’s “Team Birth Project.”
In an effort to improve maternal and infant health, the pilot program shows promise for reducing C-section rates and making those that happen as healthy as possible. Team Birth Project works to increase collaboration between all parties involved in childbirth and prioritizes reducing the “gray area” that helps the members of the birth team decide what actions are necessary for the best outcomes for mom and baby. The foundational methods used to reduce medical interventions are much simpler than one would think.
Uniquely, pursuant to the Team Birth Project, mothers are not admitted to the hospital until they are in active labor. The mother’s birth preferences, which would traditionally be referred to as a “birth plan,” are used to guide the labor team in what strategies they used when treating mom and baby. And lastly, the delivery plan is placed on a whiteboard in the patient’s room to provide to remind everyone of the goals and expectations for the birth. The plan is adaptive and evaluated for effectiveness when necessary — hence its presence on an erasable whiteboard.
From there, the plan is separated into three categories to independently assess the needs of mom, baby, and the progression of labor. Another thing that makes this method exceptional is the “Next Assessment” section of the board that openly informs mom and loved ones about what is happening next and increases clear communication between the patient and the medical staff.
Although it seems like it would be common sense to provide the mother in labor with thorough information on the plan of action for her delivery, many medical professionals don’t. The internet is littered with firsthand accounts of women who felt overlooked if not dehumanized during birth and left with residual trauma.
South Shore’s Team Birth Project Pilot began in April 2018, and the program is currently in test mode at three other facilities: Saint Francis in Tulsa, Oklahoma; EvergreenHealth in Kirkland, Washington; and Overlake in Redmond, Washington.
In the last four months, South Shore’s Cesarean rate has dropped from 31 percent to 27 percent — which amounts to about four fewer C-Sections a month.
Gene Declercq, a professor of community health sciences at Boston University School of Public Health suggests insurance companies are starting to exclude hospitals with high C-section rates in their networks. While harsh, that shift can serve as another motivator for hospitals to do more to improve birth outcomes and unnecessary procedures.
He also notes the role that the increased communication in the delivery room can help to improve those outcomes.
Communication during birth is key. Mothers and loved ones deserve the opportunities to be an informed participant in their birth process. Not only does it make for a more comfortable birth experience, it might be the key to live-saving medical improvements.