Following Mother Nature’s Lead

Commitment to Low-Intervention Birthing Promotes Low C-Section Rates at Sentara RMH

A baby’s birth is one of the most joyous and memorable moments in a family’s life. Often, expectant mothers envision the perfect birthing experience as a natural delivery with minimal medical intervention. The Family Birthplace team at Sentara RMH Medical Center strives to provide each family with a childbirth experience that meets their unique needs and honors their birth preferences. As a result of this patient-centered approach to care, Sentara RMH has a history of achieving low cesarean section (C-section) rates.

In 2018, C-sections made up just 29.8 percent of all deliveries at Sentara RMH—falling below the national average of 32 percent in 2017, according to the most recent data from the Centers for Disease Control and Prevention (CDC). The hospital’s C-section rate also is below Virginia’s 2017 average rate of 32.6 percent.

“Expectant moms sometimes are anxious about giving birth in a hospital, thinking they may receive unnecessary medical interventions,” says Sabrina Shiflett, BSN, RN, NE-BC, director of patient care services for the Family Birthplace. “We’re proud that our providers and nurses place an emphasis on allowing labor to progress on its own. We want to help patients achieve a vaginal birth with as few interventions as possible, as long as doing so is medically appropriate. Our medical providers and nursing staff do a great job of collaborating with our patients, and we are committed to helping each mom achieve her desired birth goals.”

Although C-sections are the most common surgeries performed at U.S. hospitals, according to the CDC, vaginal birth is still the safest and preferred method of delivery. Women who are able to give birth vaginally generally have less pain, a reduced risk of infection and a faster recovery.

Over the past several years, C-section rates across the U.S. have decreased due to a nationwide focus on improving maternal mortality rates. Sentara RMH is committed to that effort, reserving C-sections for certain high-risk pregnancies or medical emergencies.

“Our ultimate goal is a safe delivery, with a happy, healthy mom and baby,” says Terri Horst, BSN, RN, RNC-OB, C-EFM, manager of the Sentara RMH Family Birthplace. “We offer patient-centered care, meaning the patient comes first in everything we do. We want all of our moms to feel empowered to partner with us to ensure they have the birth experience they desire.”

Letting Nature Take Its Course

A low-intervention birth means allowing labor to progress at its own pace, without the use of medications or other techniques to speed up the process. The term also generally refers to using zero—or very limited—pain medications. The 10 birthing suites at the Family Birthplace are designed to facilitate low-intervention techniques during labor, and each room is equipped with items to promote nonmedical pain management, including Jacuzzi tubs, positioning bars, birthing stools and birthing balls. Other available comfort measures include massages, aromatherapy and nitrous oxide—a mild gas that helps patients relax.

Women are encouraged to move around and walk during labor at the Family Birthplace. For low-risk pregnancies, intermittent monitoring or portable fetal monitors allow movement, and waterproof equipment can be used in the whirlpool tubs.

Laboring moms may invite a limited number of care partners into the room for support, including a significant other and a doula. They also are encouraged to bring comfort items from home, such as blankets or pillows, or a soothing music playlist.

“Women can come to the Family Birthplace and have an experience that meets their family’s needs,” Horst says. “We offer many amenities to facilitate a low-intervention birth, in a safe environment with an experienced medical team that is ready to intervene, should a problem arise.”

Planning Ahead for Labor

Healthy, low-risk patients—those without complicating conditions such as high blood pressure or diabetes, for example—may be candidates for low-intervention labor and delivery. While there’s no right way to do a low-intervention birth, women should discuss their personal preferences and medical concerns with their OB-GYN or certified nurse midwife during the early stages of pregnancy. Whenever possible, providers strive to accommodate patients’ preferences.

“Everybody is different, and no two births are alike,” Shiflett notes. “It really is critical to establish that relationship early on, so that the provider knows what the patient values most in her birthing experience. When the mother arrives at the hospital, our nurses will continue that conversation, advocating for and facilitating the patient’s preferred way of giving birth. Our nurses are highly trained, and we are dedicated to providing safe, compassionate care to every family.”

Shiflett encourages expectant mothers to take advantage of the hospital’s array of resources and educational opportunities to prepare for labor and delivery. Sentara RMH strives to connect with patients early in pregnancy, offering childbirth, breastfeeding, sibling, infant CPR and family care classes; tours of the birthing facility; and guidance on how to stay healthy during pregnancy.

“Every woman has a different expectation for birth, and every woman experiences pain and discomfort differently,” Shiflett says. “We are able to accommodate moms for whatever kind of delivery experience they might desire. If a new mom wants to have a natural birth, our nurses are very skilled in offering comfort measures to assist them during their birth experience. If someone is thinking about a low-intervention birth, but then ends up needing more intervention as labor progresses—up to and including C-section—we can easily and readily convert to that level of care.”


Certified Nurse Midwives Celebrate 25 Years of Practice at Sentara RMH Family Birthplace

Women want choices—particularly when it comes to the childbirth experience. Across the United States, a relatively small but growing number of women are turning to midwives to attend their babies’ births. In 2017, about 9.1 percent of all births in the U.S. were attended by a certified nurse midwife (CNM) or certified midwife, according to the American College of Nurse-Midwives.

Sentara RMH Medical Center has long offered this option to women with low-risk pregnancies. In fact, this summer marked the 25th anniversary of nurse midwifery at the hospital. These CNMs—advanced-practice registered nurses who have earned an additional degree and certification in nurse midwifery—practice in collaboration with the physicians at Shenandoah Women’s Healthcare and Harrisonburg OBGYN Associates. Along with providing prenatal care and attending births, CNMs offer well-woman care, nutrition counseling and wellness education.

As specialists in low-risk, healthy pregnancies, CNMs are prepared to guide laboring women through a wide range of low-intervention birth techniques. For each woman, however, the idea of how to achieve a low-intervention birth may vary.

“It’s a balancing act, but nothing is black and white when it comes to low-intervention birthing—there are many ways to accomplish that, and each woman should know her options,” says Melody Mast, MSN, CNM, WHCNP, who practices at Shenandoah Women’s Healthcare. “Every birth should be one that empowers a woman to be a better mother to her baby.”

Any low-risk pregnancy can suddenly take a turn, and CNMs are trained to recognize when problems arise and medical interventions are needed. At Sentara RMH, the close working relationships between the CNMs and their practice physicians means that, when needed, women experience a smooth transition to a higher level of care.

“The hallmark of the CNM’s approach is our collaborative partnership with the physicians in our practices,” says Anastasia Suslaev, MSN, CNM, a provider at Harrisonburg OBGYN Associates. “When a patient chooses to work with me, I’ll be by their side throughout labor and delivery, but my doctor will always have an eye on them as well. So if any medical emergencies should arise—which can happen even among low-risk patients—our physicians can step right in and handle any interventions that might be needed. Together, the CNM and the physician can give the safest care possible.”

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