Cesarean Section Case Study

The intent of this paper is to examine effective solutions for reducing cesarean deliveries. Cesarean deliveries involve more risk to both the mother and baby than vaginal births do. Cesarean deliveries have a higher potential of complications than vaginal births. Cesarean deliveries cost more, require longer hospital stays, and require more resources—both human and systemic—than vaginal births.

Over the years birthing methods have changed a great deal. When technology wasn’t so advanced there was only one method of giving birth, vaginally non-medicated. However, in today’s society there are now more than one method of giving birth. In fact, there are three methods: Non-medicated vaginal delivery, medicated vaginal delivery and cesarean delivery, also known as c-section. In the cesarean delivery there is not much to prepare for before the operation, except maybe the procedure of the operation. A few things that will be discussed are: the process of cesarean delivery, reasons for this birthing method and a few reasons for why this birthing method is used. Also a question that many women have is whether or not they can vaginally

Since the discovery of Fetal Alcohol Syndrome specialists have been trying to understand the different affects that alcoholism can have on a fetus. As a result of these studies there have been several terms used to range describe the different effects the alcohol can have on a fetus. They are called Fetal Alcohol Syndrome, Fetal Alcohol Effects, Alcohol Related Birth Defects, ,and Fetal Alcohol Spectrum Disorder, and Alcohol Related Neurological Disorder. There are three primary facial abnormalities that a specialists looks for in order to make an official diagnosis of FAS .These include smooth philtrum,thin vermillion border,and short palpabrel fissures.A documentation is also made about the growth deficits and CNS abnormalities a child with CNS may face. The term “fetal alcohol effects” (FAE)is used to describe negative outcomes of maternal alcoholism that do not meet the criteria for FAS.FAE was first introduced in1978.There was research conducted by a group called Research Society on Alcoholism’s Fetal Alcohol Study Group (FASG) (Rosett 2013). Problems began to arise concerning the use of terminology to distinguish between a diagnosis of FAS and FAE

Cesarean births have been on the rise over the last decade and are associated more with failed inductions than with medical necessity. C-sections are associated with more short and long term complications for mother and baby. By promoting a pregnant woman to opt out of inductions before 40-42 weeks and educating about vaginal birth after cesarean section, the United States can drop the number of cesarean sections performed.

There has been a long debate over which birthing method women should use today: natural versus medicalized. The World Health Organization defines natural birth as a vaginal birth without the use of any.. and medicalized birth as being .. However, medicalized births are becoming increasingly popular in the United States. The use of technology and medical interventions in the birthing process has increased despite the unchanged basic physiology of childbirth. One of the most common medical interventions in the birthing process is having a cesarean delivery. Despite the known risks of having a cesarean section performed, the rates of this procedure have increased much higher than the acceptable rate of 10-15% as recommended by the World Health Organization. This is due to the reason that cesarean sections are now being performed as a matter of convenience of the physician or at the request of the patient more often than being performed as a life-saving intervention. Thus making surgical and medicalized interventions a part of a common routine in the childbirth experience.

Also in the year 2008, despite declining to 4.2 million total births from a high of 4.7 million births in 2007, most of these (67%) were delivered vaginally, and the majority of vaginal deliveries (84%) occurred without complications or serious procedures in hospital births.

Lutheran Medical Center (LMC), one of eight hospitals in the Sister’s of Charity of Leavenworth Health System, had the second highest cesarean section rate in the system in 2014 (SCL Health, 2015). Westside Women’s Care (WWC), a privately owned obstetrics practice, employs 14 providers who attend approximately 65% of the births at LMC. WWC’s primary cesarean section rate from March 2014 to March 2015 was 34.8%, the highest of all LMC provider groups. The primary cesarean section rate in Colorado in 2012 was 17.4% and the Healthy People 2020 goal for primary cesarean section is 23.9% (Osterman & Martin, 2014; U.S. Department of Health and Human Services, 2015). To help decrease the primary cesarean section rate at WWC and subsequently LMC, a quality improvement project (QIP) team was formed composed of providers from WWC and administrators and nurses at LMC. A root cause analysis was conducted and Fishbone diagram were developed (See Appendix A). Several themes emerged as contributing to the high cesarean section rate. These included: 1)

Shah then goes on to state how cesarean surgeries may be beneficial, or may not be beneficial to the mother, but are most likely unbeneficial to the newborn, unless there is a serious threat. Shah states, “ … that those born by cesarean were significantly more likely to develop chronic immune disorders.” of which he acquired from a Danish study from two million children born at full term. In contrast Dr.Shah states how many of his patients benefit from his surgeries, even though he stated previously how dangerous they were, and how he gets to save lives and bring new ones into the world. Finally, Shahs closing remarks are on how to fix the overuse of C-sections. Shah states how natural birth is the preferred way to go and that cesarean surgeries should be only for emergency use only and not for choice. In addition, Dr.Shah goes on to say how a perfect way to fix the overuse is to take the “British way” and to “...stay away from obstetricians altogether - at least until you need

Vaginal birth is not a easy trip for a baby. These days the death rate in U.S. for full-term babies is 2 in 1000. According to some experts a C-section during the week the woman is due would save lives.

Cesarean birth can be lifesaving for the fetus, the mother, or both in certain cases. However, the rapid increase in cesarean birth rates from 1996 through 2011 without clear evidence of concomitant decreases in maternal or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused (Caughey,

The purpose of this handbook is to advise expectant mothers to avoid getting a C- section when it is time for them to give birth. In addition, the report discusses what a C-section is and the risk factors associated with it. This report points out that many doctors and hospitals tend to preform unnecessary C-sections in order to gain more money.

"Women who undergo vaginal births avoid major surgery and its associated risks, such as severe bleeding, scarring, infections, reactions to anesthesia and more longer pain." (Nierenberg) For the mother, "the experience of actively delivering a baby is exciting and empowering. (Why Choose Vaginal Birth). "Vaginal birth is the essence of femininity to most women. It biologically and physically links all women. It is also an expression of a woman's sexuality." (Why Choose Vaginal Birth) Another reason that women would rather have a vaginal birth is because, "from a psychological standpoint, women who go through with a vaginsl delivery are said to have a more positive birthing experience." (Vaginal Delivery vs C-Section) There are several positives for the baby in a vaginal delivery. One positive is, "during a vaginal delivery, muscles involved in the process are more likely to squeeze out fluid found in a newborns lungs." (Nierenberg) "Babies born via vaginal delivery tend to

Often feeling the pressure of family and the uncertainty of the baby’s arrival can be a motivating factor toward choosing a planned birth. The mode of delivery in many ways can be up to the discretion of a physician, more so because “the medical community’s fear of litigation” even so “Obstetric nurses are 10 times more likely to be in the courts” as oppose to non-obstetric nurses(Sibbald, 2003, para. 3). The advantages of performing a ECS is having the patients preferred healthcare provider available and “greater ease of balancing staffing levels with clinical volume”(Salim & Shalev, 2010, p. 4). Ultimately, avoiding patient morbidity and fatigue with the healthcare team can contribute to a positive outcome. Although, scheduling birth based on timing and convenience can be a motivating factor for CDMR. It’s been “shown that respiratory morbidity in Elective Cesarean section is inversely related to gestational age at the time of ECS” (Ramachandrappa & Jain, 2009, para. 9). With

As stated by Penny Simkin, April Bolding, Ann Keppler, Janelle Durham, and Janet Whalley, the authors of the number one best-selling book, Pregnancy, Childbirth, and the Newborn: The Complete Guide, “While maternity care practices are continually changing the way women are helped to give birth, childbirth itself hasn’t changed. How a women’s body functions during pregnancy, labor, birth, and the postpartum period—and what she needs during these things—hasn’t changed since the beginning of humankind.” The process of birth is one of God’s greatest miracles. Although all babies go through the same stages of conception and development while in utero, that “average gestation period is 280 days, but it can be shorter or longer by as many as 14 days. At the end of the gestation period, the fetus has reached full term and is positioned for the birth process. The process, generally referred to as labor, includes three stages” (Wittmer, Petersen, Puckett, 2013, pg. 103). However, not all babies are born through vaginal births and as technology has increased many doctors are beginning to see a trend of patients asking for elective C-sections for non-medical reasons for convenience and avoiding the pain of labor, as well as concerns about vaginal tearing, incontinence, or other complications.

Vaginal birth after caesarean (VBAC) is the name used for identifying the method of giving birth vaginally after previously delivering at least one baby through a caesarean section (CS). A trial of labour (TOL) is the term used to describe the process of attempting a VBAC. An elected repeat caesarean (ERC) is the other option for women who have had a caesarean in the past. The rates of women choosing to deliver by means of an ERC has been increasing in many countries, this is typically due to the common assumption that there are too many risks for the baby and mother (Knight, Gurol-Urganci, Van Der Meulen, Mahmood, Richmond, Dougall, & Cromwell, 2013). The success rate of VBAC lies in the range of 56 - 80%, a reasonably high success rate, however, the repeat caesarean birth rate has increased to 83% in Australia (Knight et al., 2013). It is essential to inform women of the contraindications, success criteria, risks, benefits, information on uterine rupture and the role of the midwife in relation to considering attempting a VBAC (Hayman, 2014). This information forms the basis of an antenatal class (Appendix 1) that provides the necessary information to women who are considering attempting a VBAC and can therefore enable them to make their own decision regarding the mode of birth.