Doylestown Health Nurses Aim to Lower C-section Rate

Across the country, about 10,000 babies are born every day, with about a third of them delivered via Cesarean section (C-section). Roughly 32 percent of all births are C-section births. And about 26 percent are among women who were considered to be at low risk, according to the most recent data from the Centers for Disease Control and Prevention. ¹

According to public health experts, these percentages are too high, especially among low-risk pregnancies. Although C-sections are relatively safe, they do have risks, including the possibility of additional surgeries, infection and blood clots. The recovery is also more difficult for the mother and that can make it more challenging for her to care for her baby.

Preventing Unnecessary C-sections

Thankfully, hospitals nationwide are taking initiatives to lower their C-section rate. As part of that push, Doylestown Health’s maternity nurses learn and implement various strategies to help moms in labor.

“Really, what we’re doing is promoting vaginal birth instead of a surgical birth,” says Janey Ierubino, RNC, DNP, clinical nurse educator at the VIA Maternity Center at Doylestown Hospital. “… Moms should understand that having a C-section is major surgery. It’s not the best way to deliver, so if we can prevent C-sections, we should.”

Of course, there are times when a C-section can be life-saving to either the mom, baby or both, Janey says. But many times, a C-section can be prevented in low-risk mothers. A lot of prevention boils down to educating the nurses with innovative strategies who then share that information with their patients.

Introducing Comfort Measures

Part of those strategies includes relaxation techniques that can help promote a vaginal birth. Hydrotherapy is one intervention that can make a world of difference for some laboring moms, which nurses encourage. Now, all patient rooms are equipped with a handheld showerhead that moms can use to massage their body. “Just being in the shower tends to relax women,” says Janey.

Nurses are also learning about pain control theories and using acupressure and massage to help women cope better in labor. These techniques can help the mother relax tightened muscles and ligaments. By relaxing these soft tissues, it can promote cervical dilation and speed up the labor, Janey says.

Smarter Use of Technology

One recent change in maternity is a focus on less-invasive technology and to monitor patients intermittently, rather than relying on continuous monitors that are attached to the mother. By not being connected to machines for long periods, low-risk moms are allowed more freedom of movement. Janey explains that the mother’s movement helps the baby change positions and navigate through the pelvis.

However, some technologies can help reduce the C-section rate. One of those is intrauterine pressure catheters used in conjunction with Pitocin (the uterine contraction medicine that helps the cervix dilate). These devices help maternity nurses monitor the patient’s contraction intensity, ensuring the contractions are strong enough to effectively move the baby through the birth canal before a C-section is called for “failure to progress.”

Intermittent monitoring gives the mother the ability to use non-pharmacological pain control strategies like sitting on a birthing ball or rocking chair and getting in the shower, allowing for more movement.

“Unfortunately, once we interfere with natural labor by limiting the mother’s movement, we often need to use Pitocin and this can cause more pain and this often leads to the need for pain control methods like an epidural. Once one intervention is started, it leads to another. It’s like a domino effect,” notes Janey. “Epidurals provide excellent pain relief, but they can limit the mother’s ability to push and this often leads to a C-section.”

Understanding Pelvic Dynamics

To counter the side effects of an epidural, nurses are trained to use strategic positioning to open the mother’s pelvis and facilitate the descent of the baby. For example, they use a peanut ball (an exercise ball in the shape of a peanut) with moms to increase the pelvic diameter and help the baby descend. “The nurses know the peanut ball works. But it’s not as simple as sticking the peanut ball between the mom’s legs. We can position the peanut ball and the mom’s legs in a certain way that will change the diameter of the pelvis based on where the baby’s head is.”

Another technique nurses are using is called “closed-knee pushing.” Instead of the traditional way of pushing with legs far apart and back, the knees are bent, legs next to each other. This changes the outlet of the pelvis, making it bigger, according to Janey.

Positioning the mom this way may provide an extra half an inch of room in the pelvis. This can be critical in preventing some babies from being stuck and lead to a C-section, she explains.

Overall, the C-section rate is fixable, and nurse education is the first step, says Janey. “Our staff is open to help prevent unnecessary C-sections. We all want to learn more and become better nurses so we can provide the best care for our patients.”

1. Births: Provisional Data for 2019, Vital Statistics Rapid Release, Number 008 (May 2020).