Communication Reduces the Rate of Cesarean Birth

by Bonita Katz, BA RN ICCE ICBD IAT CLC

Just last week, The New York Times published a commentary by Allison Yarrow entitled “One Hospital’s Plan to Reduce C-sections: Communicate.” The article describes the role communication plays in reducing the cesarean birth rate. (As a side note, I rejoice that physicians, healthcare systems, and American society in general are finally openly recognizing that the cesarean rate has climbed too high.  When I joined ICEA almost 30 years ago we were bemoaning the sky-high cesarean rate of 23%… and yet the rate continued to climb. The rising rate could have been justified if outcomes improved, but they did not. I will not rehash here what NPR, USA Today, Consumer Reports, and others have covered in the past year or more.) Let’s talk about this concept of communication.

Ms. Yarrow cites the example of a hospital in Washington State that has started using white boards to improve communication. The article asks, “What’s on the board? First, the name of every labor and delivery team member – birthing woman, obstetrician, nurse, doula and partner.” A birth team – the woman and all of the people caring for her – right at the top of the board. Why didn’t ICEA think of that? Oh, wait… we did! For as long as I can remember ICEA has been teaching about the circle of care. You remember the graphic from last month, don’t you? The pregnant person is in the center. She is surrounded by those who aid in her decision-making and who offer her support.

The article continues to explain the use of the white board. Next on the board the woman’s birthing preferences are listed. This ensures that everyone is aware of what is important to her because they are displayed where they can be seen by everyone. Lastly, the status of mom and baby and of labor progress is listed. The article states, “All conversations about labor and the laboring woman are supposed to occur with her present.” These are both ways of honoring a person’s autonomy, ensuring that they have the ability to make the decisions that are right for them.

These are steps in the right direction, but keep in mind ICEA’s philosophy:

Family-centered care consists of an attitude rather than a protocol. It recognizes a vital life event rather than a medical procedure. It appreciates the importance of that event to the woman and to the persons who are important to her. It respects the woman’s individuality and her sense of autonomy. It realizes that the decisions she may make are based on many influences of which the expertise of the professional is only one. It requires that all relevant information be made available to the woman to help her achieve her own goals, and that she be guided but not directed by professionals she has chosen to share the responsibility for her care.

For almost 60 years, ICEA has supported the concepts of family-centered care and informed decision making. We can promote good practice and evidence-based care, but we must also foster an atmosphere of respect. As childbirth educators and doulas, we are in an excellent position to facilitate communication and respect … and the time is ripe for us to do just that.

One more note: ICEA has partnered with Lactation Education Resources (LER) which provides online courses in basic lactation management for doulas and childbirth educators, training for IBCLC certification, continuing education for IBCLCs and other health care providers, and training for hospitals to achieve Baby Friendly status. For more information, please visit our website.