By REBECCA ISENHART
NISKAYUNA — The late stages of a pregnancy can be a frustrating, uncomfortable wait, but it’s important not to rush to cross the finish line. That’s the message the New York State Perinatal Quality Collaborative has for moms and doctors. It’s a message that the group, housed under the state Department of Health, drove home last month by awarding honors to hospitals that reduced medically unnecessary births before 39 weeks’ gestation.
“Preterm birth can lead to severe health problems, including difficulty breathing and feeding, vision impairment and developmental delays,” acting state Health Commissioner Dr. Howard Zucker said in a press release. “The brain is the last major organ to mature in babies; the more prematurely a baby is born, the more likely it is that bleeding or other stressors will affect the brain. Babies need a healthy start, and full-term pregnancy helps them get that start.”
Easier said than done, of course, if you’re the one carrying a heavy, wiggly baby and anxious for relief.
Even Melinda Kane agrees, and as the Niskayuna representative for the Capital Region chapter of the International Cesarean Awareness Network (I-CAN), she’s a crusader for full-term pregnancies and natural births.
“By the time you hit your due date, you’re like, ‘Really? Come on,’ ” said Kane, who has a 9-year-old son and a 7-year-old daughter. “[Moms] all want to be done being pregnant.”
Though it may be tempting, one of very few things you shouldn’t schedule is your baby’s birthday.
“What we’ve learned over the last decade is it’s not as safe as they thought, and a lot of those babies end up going to the NICU [Neonatal Intensive Care Unit],” Kane said. “And they didn’t need to be born yet, if everybody could’ve just waited a little longer.
“Being full-term is sort of anywhere from 38 and 42 weeks, you might go into labor,” she added. “It’s not every baby that’s done at 38. That’s just the early side of average.”
Several Capital Region hospitals are clearly on the right path to reducing medically unnecessary pre-term births, including Bellevue Woman’s Center in Niskayuna, which earned an award for improvement between July and December of 2013. During that period, the hospital reported fewer than three preterm births that weren’t precipitated by immediate medical need.
Bellevue is an appropriate place to examine the direction of health care for moms and their babies during pregnancy and birth.
“In my profession it’s unusual to come across a facility that’s this dedicated to women’s health,” said Dr. Nicolas Kulbida, a hospitalist and obstetrician/gynecologist.
In addition to reducing early births, Kulbida and Kane share another common goal for women’s health: reducing medically unnecessary cesarean sections.
This is something medical professionals agree on, although they’re not entirely sure how to make it happen. Part of the problem with reducing medically unnecessary labor inductions and cesarean sections is simply defining what’s needed and what isn’t.
“Obstetrical surgery is probably the most common form of surgery,” Kulbida said. “Whether they’re necessary or not depends on a lot of different factors.”
Mandatory or not, cesarean sections present risks, most of which are fielded by the expectant mother. Kulbida cites troubles such as infection, injury, and the risk of post-surgery blood clots as health problems that can potentially follow a C-section.
As recently as 50 or 60 years ago, the risks of anesthetizing and operating on a pregnant woman simply to help relieve the discomfort of pregnancy would have been too great. But safety and surgical practices have improved so rapidly that in favor of something predictable, carefully scheduled, and for many, less scary, women and their doctors sometimes opt for C-sections over natural births.
Of course, sometimes certain conditions faced by mother, baby or both make a C-section the safest delivery option. But Kulbida said it’s an option that has become too widespread.
All this has led, nationally, to about 33 percent of all births coming via cesarean section. At Bellevue, in 2014, the number was 30 percent.
“We’re under the national average, but there’s still more to do,” Kulbida said. He hopes the hospital will achieve a cesarean section rate of between 10 percent and 12 percent by 2020.
“For most people, they would think that’s an unreasonable goal,” he said. However, with education, communication, and patience, he believes it’s entirely possible to reach.
The simplest way to avoid a C-section is just to step back and wait for nature.
“Sometimes, in some cases, what you need is just more time,” he said. But again, that’s easier said than done.
“Time is a real commodity,” Kulbida added.
Kane, who works with lots of local expectant mothers, said Bellevue’s unique system of care allows for just that. Hospitalists like Kulbida are focused specifically on goings-on at the hospital; they don’t take on patients for other conditions or treat them pre- or postpartum, as private practitioners do. That, she said, gives them the opportunity to wait, because there’s no need to hurry back to their offices for other appointments.
Another course of action that Kane and Kulbida agree on is providing knowledge to both mothers and their doctors. “We need to try to re-educate everybody,” Kulbida said. While Kulbida’s focus is doctors, Kane’s is mothers. “I think educating women about the importance of these last couple of weeks of pregnancy is important,” she said. “Every mom goes in wanting to do what’s best for their baby.”
Finally, the last step in reducing C-sections may be to rebalance priorities, to make sure that the health of expectant mothers is given a little more weight.
Kulbida said in the case of a cesarean, moms often take a backseat to concerns about their newborns.
“The risks for the baby are minimal,” he said. “Any operation tends to slow people down. The only way to avoid those risks is to just not do it.”