the number of cesarean deliveries in Pennsylvania’s
Allegheny Health Network spiked last year, obstetrical
department leaders issued new guidelines on when to perform
them and began monitoring doctors’ individual cesarean
really took just a month or two, and the rates plummeted down
to where they’d been historically," which is
percentages in "the upper 20s, low 30s," said Allan
Klapper, the network’s chairman of obstetrics and
vigilance and new thinking both may play into the medical
profession’s efforts to lower the nation’s cesarean rate.
About one-third of babies are delivered by cesarean, and the
American College of Obstetricians and Gynecologists says the
surgery — riskier in some ways than a vaginal birth — is
February, the college issued its own guidelines aimed at
reducing cesareans. Noting that slow labor is a common reason
for a cesarean, the guidelines attempt to change expectations
about the amount of time involved.
now shows that labor actually progresses slower than we
thought in the past, so many women might just need a little
more time to labor and deliver vaginally instead of moving to
a cesarean delivery," college member Aaron B. Caughey
said when the guidelines were issued.
guidelines also call for more frequent use of techniques for
turning babies who are in the breech position, of using
forceps to facilitate vaginal births and of developing better,
more standardized methods of fetal heart monitoring. Concerns
about the baby’s heart rate are another frequent reason for
college especially wants to promote vaginal birth among
first-time mothers because data show that women who have one
cesarean likely will deliver in the same manner a second time.
when women who have had a cesarean become pregnant again,
doctors and midwives should help them understand their options
and calculate the likelihood of a successful vaginal birth,
said Hyagriv N. Simhan, vice chairman for obstetrical services
at University of Pittsburgh School of Medicine and medical
director of obstetrical services at Magee-Womens Hospital of
so doing, a higher proportion of women may choose a vaginal
birth after cesarean," Dr. Simhan said. Magee’s overall
cesarean rate was 29 percent last year, he said.
released results from a study on early births provide more
caution about cesareans.
study examined 7.3 million uncomplicated births that occurred
from 1995 to 2009 in Pennsylvania, California and Missouri and
found that nearly one baby in 25 was delivered earlier than
medically necessary through cesarean or induced labor.
a lot of babies," said one of the authors, Scott Lorch, a
neonatologist at The Children’s Hospital of Philadelphia.
Patient and physician preference both seem to play a role, Dr.
study said early cesareans increased the baby’s chance of
respiratory problems, while both types of early-term births
increased the infant’s hospital stay.
say they do face pressure from mothers who want to schedule a
birth for convenience, and Jan Mallak, an Export resident and
founder of Heart and Hands Doula Service, decried what she
called the "too posh to push" culture.
are hired, often on a private-fee basis, by women seeking an
unmedicated, vaginal delivery. Doulas attend their clients at
hospitals, birthing centers and in the expectant mom’s home.
They offer emotional and physical help to mothers before,
during and after delivery.
college’s new guidelines cite "continuous labor and
delivery support" as a way to lower the cesarean rate .
O’Mara of Carrick delivered sons, Bobby, 4, and Matthew, 3,
by cesarean and wanted to increase the chances of a vaginal
birth for 10-month-old Joshua.
her realize her goal, she hired a doula from Heart and Hands
— and called it the best $600 she ever spent. "She was
worth her weight in gold," she said, also praising the
Magee midwives who delivered Joshua.
Moyer of Perry, Lawrence County, said her experience with
Blessed Arrivals doula service last year was so positive that
she would "shout it from the rooftops."
vaginal deliveries of sons, Zachary, 7, and Colby, 3. For
Charlotte, who will turn 1 in September, she also wanted her
vaginal delivery to be unmedicated. She said she hired a doula
because she thought she would need more support than her
husband, Ryan, could provide.
though the nation’s overall cesarean rate has hovered around
33 percent in recent years, some say interest in doulas
already is on the rise. Mallak said her monthly "meet the
doulas" at an area restaurant are "jammed every
in midwives, who perform vaginal deliveries in hospitals and
other settings, also is said to be increasing among women
interested in natural births.
are struggling to keep up with the demand," said Ann
McCarthy, clinical director of the Midwife Center for Birth
and Women’s Health in the Strip District. The center’s
midwives last year delivered 423 babies, with an overall
cesarean rate of 8.5 percent
the college’s new guidelines — such as allowing more time
for labor — reflect doulas’ beliefs.
long as the mother and the baby are both stable, there isn’t
really a reason to not let