Back to basics

At Paradise’s Adventist Health Feather River Hospital, the comforts of home birth can be found in The Birth Day Place. Recently celebrating 20 years as the hospital’s designated birthing unit, The Birth Day Place encourages the labor, delivery, recovery and postpartum processes to remain in a single room, to keep everything as smooth and natural as possible. Women often make the space their own, bringing in music and choosing what kind of support system they want present.

“It’s all about creating an environment the mom wants. And we promote nonmedical intervention whenever possible,” said Teresa Yocum, the hospital’s obstetrics director. Those intentions are reflected in Feather River’s low rates of cesarean sections, a procedure that requires incisions in the stomach and uterus to extract the baby. Out of the 783 births at Feather River in 2017, only 96—just 12 percent—were primary C-sections (the first C-section performed on a woman).

Those numbers are significantly lower than the national average. According to the Centers for Disease Control and Prevention, 1 in 3 pregnant women in the U.S. gives birth by C-section. Those rates are indicative of a significant increase in the procedure over the past several decades; only 5 percent of women delivered by C-section in 1970. By 1996, the rate had skyrocketed to 20 percent.

In an attempt to decrease the rate of unnecessary C-section births, the U.S. Department of Health and Human Services created a goal of reducing its use nationwide for low-risk first births to 23.9 percent, under the Healthy People 2020 initiative. To bolster achieving that target rate, Smart Care California, a public-private partnership that promotes affordable state health care, honored hospitals this past January that met or surpassed that goal. Of the 111 hospitals recognized, both Feather River and Enloe Medical Center in Chico made the cut.

Much of Feather River’s success can be attributed to the midwife services available at the hospital. According to Cheryl Struve, nurse-midwife at Feather River for the past 28 years, the likelihood of needing a C-section goes down to just 7 percent under the supervision of their midwives. Trained in all elements of women’s health, nurse-midwifes attend to a variety of women’s issues, from cancer screenings and breast exams to pregnancy, delivery and postpartum care. Struve believes this comprehensive approach contributes greatly to the success of the pregnancy, and can help minimize the use of medical interventions, such as C-sections, during labor.

“We see the woman as a whole,” Struve said. “It’s not just about the medical components of the pregnancy. We work with her on her nutrition, mental health, everything. There are lots of things we can talk about, from as early as four or five weeks into the pregnancy. And it’s not just about the facts like ‘you need to lose or gain weight.’ We want to help them figure out their triggers as to why they’re gaining weight, so they can be more successful in making changes during the pregnancy.”

There are a variety of reasons for the nation’s increase in C-sections, Yocum and Struve say. Some women have elected for planned C-sections to gain more control over the scheduling of the birth; knowing when and how they’ll deliver provides a sense of peace. And for doctors, a fear of litigation sometimes leads to a C-section delivery. As Struve explained, a provider can be put into a precarious position if there are any signs of complications during labor. Performing a C-section during labor distress avoids the potential for litigation, even if the surgery is not always necessary.

Most studies and health care professionals agree that there is a time and place for C-sections. According to a current analysis of childbirth in The Journal of the American Medical Association, a C-section rate of 19 percent is warranted. That statistic accounts for obstructed labor scenarios, multiple gestations, and emergency conditions, in which C-sections are most beneficial. But as the surgery rates increase beyond 19 percent, necessity decreases while the likelihood of complications during surgery goes up.

“There’s a greater chance that amniotic fluid can enter the maternal bloodstream [with a C-section],” Yocum said. “There’s an increased chance of blood clotting. The maternal mortality rate goes up. And once the surgery’s done, you’ve got six weeks of recovery time to heal from the incision.”

For all these reasons, Struve says patience is a crucial component of the birthing process. “Labor goes so much better when we don’t have to force it.”

While the pain of delivery often leads expecting mothers to ask for medical intervention, from pain medication to C-sections, Struve says there are a variety of things the birthing team can do to help move things along naturally.

“There are exercises to ripen the cervix. And we encourage mothers to move around a lot,” she said. “There are breathing techniques and different ball-shaped cushions that provide some comfort when a woman is laying on her side.”

Sometimes, however, a C-section will become a necessary means for delivery. Regardless of the method of birth, Struve stresses the importance of supporting the mother.

“Sometimes C-section moms wonder if they didn’t work hard enough during delivery. But they often worked very hard! In those situations, there wasn’t an appropriate way for the baby to come out vaginally. … The ultimate goal is to have a healthy baby and mom, both physically and emotionally.”