Early delivery can have many negative effects on a baby including developmental delays, a higher rate of cerebral palsy, anxiety issues, infant death syndrome and difficulty breastfeeding.
It is not uncommon for a mother to request early induction due to family or social concerns such as the father’s deployment or an ill family member. Mothers induced early are statistically more at risk for having a c-section, which is a higher risk procedure than a vaginal birth.
The team at Bon Secours St. Francis Health System is on a mission to change the culture of baby delivery. They have even put a policy in place that does not allow elective deliveries to be scheduled before 39 weeks and a second policy that does not allow c-sections unless there is a medical need.
St. Francis has implemented a nurse scheduler on staff who coordinates inductions and c-sections, making sure not to put either of the procedures on the schedule unless the policy has been strictly followed. If there is any debate or deviation from the policy, she seeks guidance from a perinatologist.
“It often happens that a mom is miserable or worried that her baby is going to be big and wants to be induced early,” said Dr. Edward Heidtman, chair of the Medical Staff Quality Improvement Committee at St. Francis. “But if a mother goes into labor naturally, she has a 90 percent change of delivering vaginally.”
The team at St. Francis is a part of the statewide South Carolina Birth Outcomes Initiative (BOI), which works to reduce c-sections and early inductions. In 2013, South Carolina’s c-section rate was 35.1 percent but is starting to drop toward BOI’s goal of 15 to 20 percent. In 2014, St. Francis saw a rate of 16.4 percent, falling right in the target area.
“The primary rate is most concerning. Once a mom has her first c-section, a lot of the time she will have one for the rest of her children,” said Ashley Freeman, Administrative Director of Obstetrical and Neonatal Services at St. Francis.
“As a nurse you would think I would recognize the benefits, but I did not.
There are many benefits to a vaginal birth – it is a natural process with a lower risk of infection and blood loss; the recovery time is shorter; mothers can breastfeed sooner and more successfully; and there is limited pain. C-section babies are more likely to have transitional problems such as rapid breathing rates and wet lung. But there are times when a c-section is necessary – if the baby is not in the right position, if there are multiple babies, if the baby is very large or if it is a high-risk pregnancy where the baby or mom can’t tolerate a long delivery.
So how is St. Francis changing the culture of baby delivery?
“Education of the patient is very critical in the physician’s office even before they get here, they’ll know what to expect,” said Freeman.
South Carolina mom and registered nurse Laura Cole has experienced firsthand this change in patient education.
“I was amazed with the education I received from my OB about the benefits of waiting until 39 weeks to deliver,” she said. “As a nurse you would think I would recognize the benefits, but I did not. During one of my first visits they gave me a handout about not delivering before 39 weeks unless it was natural labor. My doctor talked with me and assisted me with my birth plan and continued having the conversation throughout my pregnancy.”
St. Francis makes it a priority to educate patients early on, making sure that moms and their families know it is important to let the baby fully develop until at least 39 weeks. They also strive to educate and empower nurses and physicians so they understand the goals they want to achieve and why. It is a collaborative process.
“One of the most important things we’ve done is engagement of our physicians in the process,” said Dr. Saria Saccocio, chief medical officer at St. Francis. “They’ve done a really good job over the last 18 months bringing that number down and consistently holding it down.”
Today, about 99.8 percent of moms who deliver at St. Francis are not induced before 39 weeks.
“We’re all in this together, and it’s for the good of the babies,” said Freeman.