The Truven Health Blog

The latest healthcare topics from a trusted, proven, and unbiased source.

Creative Care Models Could Help Reduce C-Sections

By Michael R. Udwin/Tuesday, March 4, 2014
Michael R. Udwin imageThe recent article “Groups call for safe reduction of C-section” offers fascinating insight into the commendable goal of reducing cesarean sections. Born from concern for both mother and baby and increased costs with surgery, it’s easy to understand why national and local maternity care organizations are so focused on reducing c-sections for first-time moms. 

Supported in the literature and recognized by caregivers, hospitals are seeking creative ways to safely minimize the element of time when managing patients in labor. Birthing coaches or doulas have long been appreciated for their ability to reassure anxious patients unfamiliar with the complexities of contemporary labor and delivery units. They also can be invaluable as consumer advocates when sometimes dated protocols and timetables are summoned to justify surgery for a prolonged labor course.

One promising trend observed at both small and large hospitals entails the use of “laborists.” Similar to hospitalists who are present in the hospital around the clock, these physicians don’t come and go. Rather, they remain in labor and delivery for a given shift, caring for any laboring patients in the hospital during that time. Although this can be a disadvantage to those patients expecting their doctor to be present for delivery, the advantages are quite compelling. Freed from the demands of patients in the office or outside commitments on a weekend or evening, the laborist can deliver the patience likely to ensure best practice and ultimately reduce cesarean sections. 

Creative models of providing care inside and outside of maternity units are likely to be the future, as hospitals, physicians and patients adapt to an evolving landscape.  In this scenario, such changes in practice are likely to not only improve outcomes for moms and babies, but reduce costs in the process.

Michael R. Udwin, MD, FACOG
National Medical Director

Asking the Right Questions about the Necessity of a Cesarean Birth

By Michael R. Udwin/Thursday, July 11, 2013
Michael R. Udwin imageThe HealthLeaders Media article "C-Section Rate Reductions Panned" rightly applauds the drop in cesarean births prior to 39 weeks yet is unable to completely explain why such deliveries have continued to rise after 39 weeks. As suggested in the article, concern about large babies and the over-use of induction may be contributing to this phenomenon. Like so many other challenges facing the healthcare community, the key to changing outcomes rests in asking the right questions. Yes, this does sound like a cliché. But surprisingly, it is not happening often enough.

Those with access to healthcare data are in a unique position to pose and answer the right questions. Such queries could explore the indications for the surgery? How many cases started as inductions? And are these inductions “necessary?”

It is instructive and perhaps not coincidental that early elective deliveries declined as hospital rates were publicly published. This suggests that providers are indeed sensitive to patient perceptions and concerns. With this in mind, it is up to both doctor and expectant parent to not just pose the above questions but also adjust behavior based on the answers.

It is a common refrain in hospitals, “mothers come to have a healthy baby, not to have a natural delivery.” This is indeed true, but it does not preclude ideally doing both whenever possible.

Michael R. Udwin, MD, FACOG
National Medical Director