Reducing C-Sections by Improving Communication

While C-sections are now routine and relatively safe, they still carry more risk for mothers and babies than vaginal births. In an effort to reduce the growing number of unnecessary cesarean deliveries, South Shore Hospital, located in Weymouth, Mass., has teamed-up with Ariadne Labs, a joint center between Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health, to implement a new initiative aimed at empowering women to communicate their birth plan and share in the decision-making process during childbirth.

“We’re fairly confident that, when you look nationally, the plurality—if not the majority—of C-sections are probably avoidable,” said Dr. Neel Shah, director of the Delivery Decisions Initiative at Ariadne.

To achieve this reduction, they’ve piloted the Team Birth Project, which aims to make communication transparent among parents, doctors, nurses, and the rest of the labor team. The project works to remove what Shah calls the “huge gray zone” in a labor team’s shared understanding of goals, which can lead to a C-section because there’s no clear agreement on what’s best to do next. The early results are promising: Over the initial four months of the pilot at South Shore Hospital, the first of four hospitals in the country to take part, the primary, low-risk C-section rate decreased from 31% to 27%, about four fewer C-sections per month.

The project has members of the labor team map out the delivery plan on a whiteboard in the delivery room, allowing parents to participate.

“It forces us to stop and think about everything with the patient,” said Dr. Ruth Levesque, an OB/GYN at South Shore. “It makes us verbalize our thought process.”

The mother’s preferences, such as whether she wants an epidural or whether she prioritizes immediate skin-to-skin contact with the baby, are central to this plan from the start. The team then refers to and updates it throughout labor and birth so that everyone—including mom—knows exactly what’s happening next.