Local hospital pilots childbirth program to reduce C-sections, improve communication

BOSTON — For many moms and newborns, a Cesarean birth is a must. The operation can be the difference between life and death.

Over the past few decades, however, there’s been a growing concern that too many C-sections are performed.

The South Shore Hospital in Weymouth is the first facility in the country to pilot a new approach to bring those numbers down. It has implemented a protocol called "Team Birth Project" that’s used during the birth process. %



Melisa Burns and Cam Roller of Scituate recently added Nora to their family and they noticed some big changes when they got to South Shore Hospital to have their new daughter.

“They really paid attention to us, asking 'Are you interested in having midwives be present?' and really giving us options,” said Burns.

Their preferences found their way onto a simple whiteboard, which is the centerpiece of this approach to have a baby using the Team Birth Project protocol.

Roller noticed changes right away. %



“I am seeing they are writing everything that we are saying," he said. "They literally have a game plan. It was like you were on a team and that’s their game plan.”

The goal is to provide a simple structure to improve communication among all the key parties, including the patient, their support person, the nurses and the provider.

Dr. Kim Dever, chair of obstetrics and gynecology at the hospital, said this emphasis on open communication can help reduce the number C-sections. The rise in the number of C-sections performed has also brought an increase in the number of complications from the procedure, she said.

South Shore Hospital has seen a 4 percent reduction in the number of unnecessary C-sections since they implemented this new approach last spring.

It’s not just the mothers who benefit, according to Dever.

“Many babies who are delivered sort of electively by C-section, or for many other reasons, don't transition well because they don't get that squeeze and that kind of message to their brain saying, ‘Oh, you are being born now, you need to learn to breath and survive on your own,'” she said.

Ariadne Labs, a Boston-based research organization that tries to find simple and inexpensive solutions to complex health issues, created Team Birth Project.

“Some patients really do need C-sections,” explained Dr. Amber Weiseth, of Ariadne Labs. “They are really important interventions and we believe in them, and we are not trying to eliminate them.”

Weiseth said the goal is to make sure patients are getting the right care for the right reasons. By improving communication, the hope is a new mom’s confidence in the entire birthing process will go up.

“We all agree on the black and the white,” added Weiseth. “We do know when we need to do a C-section, and we really know when it is not appropriate. Everyone agrees there. But to hone in on this middle section, where it is gray and fuzzy, is where we forced out attention to be.” %



Burns had a smooth delivery with Nora, but definitely sees how improving communication, even with something as low tech as a white board, could encourage more moms to delivery naturally.

“People kind of get nervous and say, ‘Gosh, I can’t do this’, but I think that’s actually the opposite," she said.

Three other hospitals, one in Oklahoma and two in Washington state, just started implementing the program.

The researchers in Boston don’t have a target rate for the number of C-sections a hospital should perform. One health policy group, Healthy People 2020, suggests a rate of less than 23.9 percent as a goal.

South Shore Hospital is now down to 26 percent and they’re confident they can continue to improve on that number using Team Birth Project.