More babies born naturally: PeaceHealth reduces C-sections

Effort targets first-time moms, those who have had procedure

By Marissa Harshman, Columbian health reporter

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Brooke Barber entered the world March 28. Her arrival was uneventful, especially compared to the entrance her sister, Cora, made two years earlier.

Sarah Barber delivered Cora by cesarean section after doctors learned the baby was in distress. But Brooke was delivered vaginally, something that had become somewhat uncommon for women who had previous C-sections.

But that weekend, Barber was just one of five women with previous C-sections who delivered babies vaginally at PeaceHealth Southwest Medical Center's Family Birth Center. And all five women were admitted within about 12 hours of each other, said Dr. Mike Farber, the center's medical director.

The women, he said, illustrate the hospital's commitment to reducing the number of C-sections.

"There's a nationwide effort, that our hospital has also adopted, to lower our cesarean section rates," Farber said. "One way to do that is to reduce the number of repeat C-sections."

The cesarean section rate increased significantly in the U.S. for about a dozen years. The rate hovered around 21 percent for much of the mid-90s before starting to climb later that decade. By 2012, the national C-section rate was nearly 33 percent, according to the Centers for Disease Control and Prevention.

The rate of C-sections in Washington mirrored the national increase. In 2010, nearly 30 percent of Washington babies were born via C-section.

As part of effort to reduce C-section rates, providers and hospitals are taking a closer look at the policies in place for women with previous C-sections, Farber said.

Allowing a woman to attempt a vaginal delivery after a C-section is riskier than performing another C-section. The scar area is weakened and is at risk of bursting open during the stress of labor, Farber said. Though the overall incidence is low, the risk and fear of litigation led many providers to repeat C-sections, he said.

Now, however, there's more of a push for attempting vaginal deliveries.

"We are trending toward more trials of labor at this point," Farber said. "Most people are successful at doing this."

Barber and her husband, Peter Barber, agreed early on that Barber would try to avoid a repeat C-section. She found a provider who supported her and was committed to her decision.

But if Barber or Brooke was ever in distress, Barber was ready to undergo another C-section. A healthy baby was most important, she said.

"You have to be realistic," she said. "Sometimes the stars don't align for you."

This time around, though, the stars did align for the Brush Prairie woman.

"She cooperated, and my body cooperated," Barber said.

In addition to reducing repeat C-sections, providers are working to bring down the number of first-time C-sections, Farber said.

Historically, providers would lean toward C-sections after a woman labored for about two hours without change to the cervix. Now, they're letting women labor for four hours without change before turning to C-sections, he said.

"We allow women to labor longer, more naturally on their own," Farber said. "We allow them to push longer."

The efforts appear to be paying off at PeaceHealth Southwest Medical Center.

The rate of C-sections has been coming down for the past several years. In 2010, nearly 29 percent of births at the hospital were C-sections. Last year, cesareans accounted for about 26 percent of births, according to data provided by the hospital.

Legacy Salmon Creek Medical Center is also working to bring down C-section rates. At the beginning of 2013, the hospital's Family Birth Center had a C-section rate of about 33 percent, said Brian Willoughby, hospital spokesman.

The hospital implemented a new campaign to end elective inductions prior to 39 weeks gestation. (For years, physicians considered women who are 37 to 39 weeks' pregnant to be full term. But new research shows delivering prior to 39 weeks can have short- and long-term health effects.) By the end of 2013, the C-section rate at Legacy had dropped to 29 percent, Willoughby said.

Avoiding C-sections typically means an easier and quicker recovery. Women, in general, do well after C-sections, but it is a major surgery, Farber said.

That was one reason why Barber wanted to avoid a second C-section, if possible. She recovered well from her first C-section, but her activity was limited for a couple weeks. With a toddler at home and her husband returning to work, Barber knew a shorter recovery the second time around would be beneficial.

"The easier that could be, the better," she said. "Better for baby. Better for me. Better recovery for our family."

But even Barber was surprised by how much better she feels.

"It really made my life easier and more comfortable," Barber said. "I just feel really good."