Reducing The Primary Cesarean Section Rate

Childbirth is one of the greatest privileges on the earth anyone could have and we, as women, should feel proud to be major contributors for it. Thus, a mother has to play a key role in aiding the healthcare workers to mitigate the health crisis associated with childbirth by performing her duties faithfully. One such associated health crisis is “Premature (preterm) birth” which occurs when the baby is born too early, before 37 weeks of gestational period (CDC, 2015). The rate of preterm birth ranges from 5% to 18% of babies born across 184 countries (WHO, 2015).

Maternal mortality represents more than the loss of lives for individual women, as it also reflects the larger value and prioritization of women 's health and threatens the health and survival of families, young children, and even the communities in which they live (Royston and Armstrong, 1989). Maternal mortality is unacceptably high (WHO, 2015b). Globally, approximately 830 women die every day from pregnancy- or childbirth-related complications (ibid.). The causes of maternal mortality are predominately preventable and can be classified into three fundamental causes: (1) medical - consisting of direct medical problems and pre-existent/coexistent medical problems that are aggravated by pregnancy, (2) underlying - social and legal conditions, and (3) health systems laws and policies that address availability, accessibility, and quality of reproductive health services (PHP et al, 2011).

The writer explained there could be no concern for fetal or maternal health during the delivery although some obstetricians tended to induce labor in all diabetic mothers to protect babies and mothers. Moreover, labor progress was supposedly assessed by old-fashioned methods, which resulted in performing unnecessary obstetrical practices. Intervention was imposed in cases of inaccurately labeled slow or abnormal labors and failures to progress. It is common practice that a primary cesarean generally produces subsequent surgical deliveries. The author realized that cesareans were performed because of insufficient data on laboring women’s

The author is a nurse in a level two trauma facility in a community of approximately fifty thousand people in Oregon. The community is a college-town surrounded by a large agricultural area. There is a minimal ethnic diversity within the community. The diversity present occurs mainly from internationally students and faculty from the college. There is a growing population of women who desire low interventional births in the community. The author has worked on the labor and delivery unit of the hospital for the last 14 years. The hospital is the only one in the area to offer trial of labor services to women who have previously undergone a cesarean section. The unit on average experiences around 1000 deliveries annually.

In the past, in the United States the majority of women delivered at home with no anesthetics; women might have received assistance through a family doctor, including midwife care (Thomas, 2011). A radical change happened by the 1960s, when hospital childbirths had become the norm, the pain of the experience was reduced by epidural anesthesia controlled by a physician. Pregnant women received education on breastfeeding and other topics during their medical visits (Thomas, 2011).

The American Association of Birth Centers (AABC) conducted a study in January 2013, this study confirmed the long standing belief that midwife-led birth centers provide a safe and effective health care option for women during pregnancy, labor, and birth. Greenville Health Systems (GHS) listened and embraced the tenet of becoming the “health care value leader in the region” by proposing the construction of a three room freestanding birthing center operated by Greenville Midwifery Care. After almost one year of service to the community, the plan is to open a second birth center near the Patewood Memorial Hospital.

Although nurse midwives do complete the task of aiding in the delivery of newborns, “they also provide health care and wellness care to women, which may include family planning, gynecological checkups, and prenatal care” (nurse.org). Nurse midwives also assist along with physicians during c-sectional births. Certified Nurse Midwives or CNMs are advanced nurse practitioners; however, nurse midwives must earn an advanced degree, a special certification, and training in order to practice midwife duties. CNMs offer similar care to that of an OB/GYN doctor; therefore they make different financial earnings. “Nursing Economics, found that when midwives work in collaboration with physicians, the birth is less likely to end in a C-section” (nurse.org). If less c- sections are performed in hospitals, it could help lower the medical costs due to paying for medication during the labor and delivery, of a natural vaginal birth. To illustrate, nurse midwives should be more prevalent in hospitals, in order to lower the financial status of medical

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.

Cesarean section (C/S) births can occur in the hospital for several reasons. Some women choose to have elective C/S birth and others require C/S births out of infant or maternal safety, complications, or by necessity. This paper discusses both elective and emergency C/S deliveries and reviews both National Guideline policy and Carilion Clinic policies on C/S births. The problem statement is: in pregnant women (population), does C/S delivery following National or Carilion policies (IV: exposure vs. none-exposure) differ in terms of patient care and outcomes concerning maternal and neonatal health (DV)?

Elective inductions are becoming increasing popular and the old wait till you go into labor is becoming something of the past. Many woman want to predict when their future offspring will be here and be able to have a plan for when to take off of work. But one thing about having these elective inductions is the fact that they are more of a social event rather than a medical necessity. Studies have shown that the elective induction group makes up more than one third of the pregnant population (Jonsson 2012, pg. 198). This means woman are volunteering to make themselves go into labor before their body is ready. Not only are elective inductions increasing but being induced has been associated with a 3 to 4 fold increase in having a cesarean section (Yogev 2013, pg.1736). A Bishop Score is done before the start of any induction. This score is based off of cervical dilation, cervical effacement and the station of the babies head compared to the ischial spines. The number produced from this score shows whether or not the cervix is favorable or unfavorable. A favorable score is a score above 7. If the score falls below this, the cervix is not favorable. “Women who were closed dilation

Caesarean sections are a common form of birth in the 21st century. Caesarean sections are performed in a variety of situations including complications in birth, emergencies, and high risk pregnancies. Usually, once a mother has one Caesarean section, all babies after will also be delivered by Caesarean section.

In many U.S. hospitals today the patient care that women receive during management of labor and delivery doesn’t look very evidenced based. Electronic fetal heart rate monitoring (EFM) is the most common form of intrapartal fetal assessment in the United States. We continue to see widespread use of EFM in low risk pregnancies. Electronic fetal monitoring is standard procedure despite numerous randomized controlled trials that have disproven its validity. It is routinely used, yet does not decrease neonatal morbidity or mortality compared to the use of intermittent auscultation. Intermittent auscultation of the fetal heart rate is an acceptable option for low-risk laboring women, yet it is underutilized in the hospital setting. Several expert organizations have proposed the use of intermittent auscultation as a means of promoting physiologic childbirth. So why do we use continuous EFM in the low risk pregnancy and what does the best evidence support and how can nurses apply the best available evidence to practice? As a patient advocate it is the nurses responsibility to answer these questions and provide the low-risk pregnant woman with current evidence about options for fetal heart rate assessment during labor.

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.

Childbirth can be described as one of the most rewarding and also painful experiences in a woman’s life. Most women choose some type of method to ease pain, however, there has been a lot of controversy over with pain management method is the most effective. According to the CDC (Center for Disease Control), In 2013, there were 3,932,181 births recorded in the United States, 32.7% of those births were surgical procedures. In 2012, 1.36% of recorded births occurred out-of-hospital, meaning these births took place mostly in homes or birthing centers. Without the option of medicine that a hospital provides, how were these women able to manage their pain during labor and delivery. There are many different methods for easing pain during childbirth, some methods involve the use of medicine and surgery, and others include natural techniques, such as hypnosis, Lamaze, and many others. It is a personal preference of the parents over which method is right for the needs of the mother and child. This can be an overwhelming decision for new parents to make because they have to take into consideration the safety of the mother and child, pain management for the mother and desire for medical involvement.

Prenatal care is widely accepted as an important element in improving pregnancy outcome. (Gorrie, McKinney, Murray, 1998). Prenatal care is defined as care of a pregnant woman during the time in the maternity cycle that begins with conception and ends with the onset of labor. A medical, surgical, gynecologic, obstretic, social and family history is taken (Mosby's Medical, Nursing, and Allied Health Dictionary, 1998). It is important for a pregnant woman as well as our society to know that everything that you do has an effect on your baby. Because so many women opt not to receive the benefits of prenatal care, our society sees the ramification, which include a variety of complications primarily