Download Hospital Maternity Guide

50
Deaconess
40
Holy Family
UPDATED: AUGUST 2014
30
Valley
20
60
10
50
Deaconess
0
40
Holy Family
30
Valley
Hospital Maternity Guide
2009
2010
2011
2012
2013
20
60
10
Sacred Heart
50
0
Deaconess
2009
40
Spokane
& Coeur d’Alene Hospitals
30
25
20
PROCEDURE
RATES
10
Total
C-Section Rates
5
All Births
2009
2010
Deaconess
Kootenai
2011
Holy Family
2012
2013
Sacred Heart
15Deaconess
Valley
Kootenai
2012
2013
Holy Family
Sacred Heart
Valley
20
16.7%
2012
Source: WA State Department of Health. Kootenai reported its own rates.
Holy Family
Valley
Sacred
Heartknowing a hospital’s
Beyond
Deaconess
cesarean and other procedure
Holy
Family
rates,
it is also important to know
Valley
your care provider’s individual
rates which are a larger determinof care you will receive.
Deaconess
2010
2011
201322.0%
2012
18.6%
16.0%
Holy Family
Valley
2012 Total Deliveries
Kootenai
9.4%
2010
2011
2012
2013
Source: WA State Health Care Authority. Kootenai rates not available.
20
35
3.5
Deaconess
ing factor
Sacred
Heart in predicting the kind
25
Sacred
Heart
5
2009
Deaconess
20
Holy Family
15
Valley
35
10
30
5
2009
25
26.0%
25.0%
25
2011
2011
30
10
Kootenai
31.1%
30.8%
30
2010
2010
NTSV C-Section Rates
35
15
Sacred Heart
Holy Family
30
Valley
20
30
10
250
2009
2010
2011
2012
2013
20
Primary C-Sections Among Low Risk, First Time Mothers
15
Sacred Heart
Sacred Heart: . . . . . . . . . 2,863
Deaconess: . . . . . . . . . . 1,777
Kootenai: . . . . . . . . . . . . 1,642
Holy Family
Valley Holy Family: . . . . . . . . . . 1,245
Valley: . . . . . . . . . . . . . . . . 623
Sacred Heart
Deaconess
Kootenai
VBAC
Rates
3.0
15
Valley
30
Sacred Total:
Heart . . . . . . . . . . . . . . 8,150
2.5
Vaginal
Birth After Cesarean
Before
39 Weeks (Data for 2013)
25
Holy Family
2.0
Deaconess
Kootenai
1.5
60
1.0
Holy Family
Early
Elective2011
Delivery 2012
Rates
2010
Sacred Heart
Holy Family
Sacred Heart
Valley
50
0.5
0.0
40
Goal: 5% or less. WA State Average (2013): 1.5%
Valley
Sacred Heart
Valley
Deaconess
20
3.5
3.0
15
3.2%
Deaconess 2010
2.5
47.7%
Vaginal Births
Deaconess
20
17.5%
1.0
3.5
0.5
3.0
0.0
2.5
2010
2011
2012
1.5
2013
0.8%
Deaconess
0.9%
0.0%
Holy Family Sacred Heart
Valley
2.0
1.5
Valley
Sacred Heart
Holy Family
Deaconess
Source: WA State Department of Health.
Kootenai reported its own rates.
1.0
Sacred Heart
0.5
25
VBAC
6.8%
65.2%
Source: Washington State Hospital Association. Kootenai rates not available.
Percent of vaginal births among women whose pregnancies were at term, had a
single fetus with vertex (head-down) presentation, and who had one prior c-section.
Source:
30 WA State Health Care Authority. Kootenai does not allow VBACs.
C-Sections
28%
Sacred Heart
Holy Family
2.0
2009
2012
Valley
34.3%
26.5%
0
2011
Holy Family
30
10
Deaconess
Deaconess
0.0
Holy Family
20
FACILITIES
Valley
15
10
Deaconess
Kootenai
Holy Family
Sacred Heart
Valley
Day Bed
Day Bed
Day Bed
Day Bed
Fold-Out Bed
Room &Kootenai
Meals
No
Room
Room**
Room & Meals
Yes
In Process
In Process
No
DF/GF/NF
V/GF/LC/LS
V/GF/LC/LS DF/GF/NF
NICU (Level IV)
Nursery (Level I)
5
2009
2010
2012
Accommodations
for2011
a Guest
2013
35
Accommodations for NICU Parents
Sacred Heart
30
Deaconess
Baby-Friendly Designated Facility
No
Holy Family
25
20Meal
Valley
Options
15
2010
NICU/Nursery
DF/GF/NF
2011
2012
Parking
NICU (Level III)
Pay Garage
3.5
3.0Patient
Valley
Rooms
LDR >Sacred
PP Heart
2.5
Photography/Video
Free Lot
Pay/Valet M-F
Free Lot
LDR > PP
Triage > LDRP
Triage > LDR > PP
LDRP
Deaconess
Yes*
Yes*Yes*Yes* Yes*
1.5
0.5Rooming-In
Free Lot
Holy Family
2.0
1.0
Nursery (Level II) Nursery (Level II)
with Baby
Routine RoutineRoutineRoutine Routine
0.0
Water Birth
No NoNoNo No
WiFi
Yes YesYesYes Yes
*Photography/Video is allowed, but not during procedures
**Or at Ronald McDonald House (free) or the Madison Inn (discounted “medical rates”)
Source: All hospitals reported their own data and policies
BLOOM SPOKANE HOSPITAL MATERNITY GUIDE 2014
1
CARE PROVIDERS & STAFF
Deaconess
Kootenai
Holy Family
Sacred Heart
Valley
Anesthesiology – 24-hour Coverage
Yes YesYesYes Yes
Family Practice Docs (attending births) 15+4 1 14 0
Lactation Consultants (availability)
Midwives (attending births)
Nurse-to-Patient Ratio (active labor)
7 Days/Week
7 Days/Week
6 Days/Week
6 Days/Week
M–Sat.
9 402 2
1:1 1:1 1:11:1-2 1:1
Obstetricians
On Site
On Call
On Site 24/7
On Site 24/7
On Call
Pediatricians
On Site
On Site
Available 24/7
Available 24/7
On Site
CHAS
Deaconess Hospital
Maternal-Fetal
Medicine
Health Care for Women
Henneberg & Kim
OBGYN
Kootenai Clinic OBGYN
Associates for Women’s
Health
North Spokane
Women’s Health
Group Health
Northwest OBGYN
Northwest Midwives
OBGYN Associates of
OBGYN Associates of
Spokane
Rockwood OBGYN
Rockwood Midwifery
Spokane OBGYN
& Midwifery
Kootenai Clinic Family
Medicine Coeur
d’Alene
Private Practices & Clinics
Attending Births
Valley OBGYN
Spokane
Providence Sacred
Heart Maternity
Clinic
Spokane OBGYN
PRENATAL & POSTPARTUM SUPPORT
Breastfeeding Classes
Deaconess
Kootenai
Holy Family
Sacred Heart
Valley
Coming Soon
YesYesYes Yes
Childbirth Classes*
Yes YesYesYes Yes
Lactation Assistance (outpatient clinic)
Yes YesYesYes Yes
Natural Childbirth Classes
Coming Soon
No
Newborn Care Classes
Coming Soon
Yes
Postpartum Support Group(s)
Coming Soon
No
Yes
Kootenai
Holy Family
Yes
Yes
No
Newborn/First Aid/CPR Newborn/First Aid/CPRNo
Yes
Yes
*Childbirth Classes may also conatin information about natural childbirth and breastfeeding.
LABOR AIDS
Deaconess
Sacred Heart
Valley
Birthing Balls & Peanut Balls
Yes YesYesYes Yes
Birthing Chairs/Stools
No NoYesNo No
Continuous Doula Care Supported
Yes
Squatting Bars
Yes YesYesYes Yes
Wireless/Waterproof EFM
Yes YesYesNo Yes
Tubs/Showers
Both (Jetted Tubs)
Yes
Both
In Process
In Process
Both (Jetted Tubs) Both (Jetted Tubs)
Yes
Showers
Source: All hospitals reported their own data and policies
2
BLOOM SPOKANE HOSPITAL MATERNITY GUIDE 2014
LOW RISK AND UNMEDICATED PATIENTS
The following options are available if your pregnancy was low risk, you and your baby are doing well in labor, and you remain unmedicated.
Deaconess
Kootenai
Holy Family
Sacred Heart
Valley
Birthing Position Choices
H
H
H
H
H
Delayed Cord Clamping H
H
H
H
H
Eating & Drinking in Labor
Yes
Yes
Clear Liquids
Clear Liquids
Clear Liquids
Fetal Monitoring
Intermittent EFM† Intermittent EFM† Intermittent EFM† Intermittent EFM
Saline Lock Routine
Skin-to-Skin Care
Routine RoutineRoutineRoutine Routine
Water Immersion Restrictions in Labor
†
Intermittent EFM†
Routine
Routine
RoutineRoutine
None NoneNoneNone None
H = Shared Patient/Provider Decision (see page 4)
Wireless, waterproof EFM available (patients can leave bed or be in tub)
HIGH RISK AND/OR MEDICATED PATIENTS
The following options are available if you or your baby has an increased risk of health problems or you are experiencing a high risk pregnancy.
This could include pre-term labor, preeclampsia, placenta issues, diabetes, fetal issues, etc. The following options also apply if at any point during
your labor you consent to medication (induction, pitocin, epidural, etc.) or there are indications that you or baby are not coping well.
Deaconess
Kootenai
Holy Family
Sacred Heart
Valley
Birthing Position Choices
H
H
H
H
H
Breech Birth Allowed No NoNoNo No
Delayed Cord Clamping H
H
H
H
H
Eating & Drinking in Labor
H
Yes
Clear Liquids
Clear Liquids
Clear Liquids
Fetal Monitoring
Continuous EFM† Continuous EFM† Continuous EFM† Continuous EFM
Routine IV Fluids
No
HRoutine
Skin-to-Skin Care (if stable at birth)
Routine RoutineRoutineRoutine Routine
Vaginal Delivery of Twins
Yes / H
Water Immersion Restrictions in Labor
†
H
Routine
Continuous EFM†
Yes
Yes / HYes
Yes
NoneNone
H
HNone
H = Shared Patient/Provider Decision (see page 4)
Wireless, waterproof EFM available (patients can leave bed or be in tub)
C-SECTION OPTIONS
Deaconess
Kootenai
Holy Family
Sacred Heart
Valley
Delayed Cord Clamping
--YesHNo No
Doulas in OR
H
Newborn Care in OR (if stable at birth)
Yes YesYesYes Yes
Photography/Video in OR
Photos Only*
H
Skin-to-Skin in OR (Operating Room)
*Photography/Video of mom and baby is allowed, but not procedures
Source: All hospitals reported their own data and policies
Yes**
--
1 Support Person
Photos Only*
Photos Only*
1 Support Person
Photos Only*
YesYesNo Yes
**With permission from the anesthesia provider
BLOOM SPOKANE HOSPITAL MATERNITY GUIDE 2014
Yes**
H = Shared Patient/Provider Decision (see page 4)
3
DEFINITIONS & EVIDENCE FOR MATERNITY CARE PRACTICES
Baby-Friendy Designated Facility
The Baby-Friendly Hospital Initiative (BFHI) is a
global program that was launched by the World
Health Organization (WHO) and the United Nations
Children’s Fund (UNICEF) in 1991 to encourage
and recognize hospitals and birthing centers that
offer an optimal level of care for infant feeding and
mother/baby bonding. The BFHI assists hospitals in
giving all mothers the information, confidence, and
skills necessary to successfully initiate and continue
breastfeeding their babies or feeding formula safely,
and gives special recognition to hospitals that have
done so.1
Birthing Positions
Evidence Based Birth says, “The best quality medical evidence shows that women should push in
whatever position is comfortable for them. It is not
necessary to be continuously upright or continuously lying down during the pushing phase. More
evidence is needed to evaluate pushing positions
in women with traditional (non-walking) epidurals.”2
Speak with your care provider to find out if your
birthing positions will be limited or unrestricted.
Breech Birth
A breech birth is one in which the baby is born buttocks or feet first as opposed to the normal headfirst presentation.
Though vaginal birth is possible for the breech
baby, certain fetal and maternal factors influence
the safety of vaginal breech birth. The majority of
breech babies born in the United States are delivered by Cesarean section as most obstetricians no
longer have the required skill set and most hospital
policies do not permit vaginal breech birth.
C-Section Rates
Total C-Section Rate: The cesarean section rate,
or total number of cesareans per 100 births, rose
dramatically for 12 years in the United States—approximately 60 percent from 1996 to 2009. The
Specifications Manual for Joint Commission National Quality Measures (v2011A) cites research which
concludes that “Hospitals with CS rates at 15-20%
have infant outcomes that are just as good and have
better maternal outcomes.”3
NTSV C-Section Rate: This measure focuses on
primary cesareans among low risk, first time mothers: nulliparous women with a term, singleton
baby in a vertex (head down) position delivered
by cesarean section. Term is defined as gestational age of at least 37 completed weeks.
“Primary cesarean deliveries account for 50% of the
increasing total cesarean delivery rate. Given its effect on subsequent pregnancies, an understanding
of the drivers behind the increase in primary cesarean delivery rates and renewed efforts to reduce
4
them may have a substantial effect on maternal
health. The top five contributors to the primary cesarean delivery rate are nonreassuring fetal status,
arrest of labor, multiple gestation, preeclampsia,
and macrosomia. All five contributors are either
subjective or depend on management style. Thus,
the decision the patient makes as to whom she will
see for her prenatal care and which physician will be
on call for her delivery may be major determinants
as to whether she will end up with a cesarean delivery or a vaginal birth.”4
Continuous Doula Care
When a laboring woman is continuously supported
by a trained doula (the doula never leaves her side),
both she and her baby experience better outcomes.
Her partner is also likely to feel more positive about
the birth. In the past, some hospitals have limited
patients to one support person in triage and during
procedures such as epidural placement. In these
instances, the mother had to choose between her
loved one and her skilled support person. The benefits of hiring a doula may be diminished when continuous care is not supported. At this point, all our local
hospitals understand the importance of Continuous
Doula Care and allow for this or are in process of providing families with unlimited doula support.5
Delayed Cord Clamping
According to Evidence Based Birth, “Delayed Cord
Clamping (DCC) promotes a healthy neonatal cardiopulmonary transition, prevents iron deficiency at
a critical time in brain development, provides the
newborn with a rich supply of stem cells, and helps
sick neonates achieve better outcomes—all with little apparent risk to mother or baby. The evidence of
benefit from DCC is so compelling that the burden of
proof must now lie with those who wish to continue
the practice of immediate clamping, rather than with
those who prefer—as nature intended—to wait.”6
H Shared Patient/Provider
Decision
For some options there are no
specific hospital policies and a
mutual decision can be made
between the patient and care
provider. Have a conversation with
your care provider about what is
possible. Prior to giving birth, some
families decide to transfer to a
different care provider that is more
comfortable supporting desired
options for labor and birth.
Informed Decision Making
Childbirth Connection provides the
following guidance on Informed
Decision Making:
“When pregnant, giving birth, and
in the postpartum period, it is your
responsibility to make informed
decisions for yourself and on behalf
of your baby. It is your legal right
to give ‘informed consent’ or make
an ‘informed refusal’ of any care
that you might undergo.
Whenever a medical procedure,
drug, test, or other treatment
is offered to you, your doctor,
midwife, or nurse is responsible for
explaining:
• why this type of care is being
offered
• what it would involve
• the harms and benefits that are
associated with this type of care
• alternatives to this care, and
their respective harms and
benefits, including the possibility
of doing nothing at the present
time (‘watchful waiting’).”18
Early Elective Delivery Rates
This measure looks at the percent of deliveries performed between 37 and 39 weeks gestation that
were not medically necessary. Babies born prior to
39 weeks gestation face higher rates of complications and are more likely to spend time in the neonatal intensive care unit.
Washington hospitals have decreased the statewide
average from 15.3% in the third quarter of 2010 to
1.5% in the fourth quarter of 2013.
Eating & Drinking in Labor
A 2013 Cochrane Review found, “Since the evidence shows no benefits or harms, there is no justification for the restriction of fluids and food in labor
for women at low risk of complications. No studies
looked specifically at women at increased risk of
complications, hence there is no evidence to support restrictions in this group of women.”8
BLOOM SPOKANE HOSPITAL MATERNITY GUIDE 2014
DEFINITIONS & EVIDENCE FOR MATERNITY CARE PRACTICES
Fetal Monitoring
offer sustained life support, advanced imaging, and
a range of surgical procedures.
The following definitions and evidence are from the
Evidence Based Birth article, Evidence-Based Fetal
Monitoring.
Level IV: Regional NICU
The highest level of neonatal care provided occurs
at regional NICUs. They are required to have pediatric surgical sub-specialists in addition to the care
required for Level I, II, and III units.
Continuous EFM: Continuous Electronic Fetal Monitoring (EFM) during labor is not supported by evidence. It is associated with a reduction in neonatal
seizures, but no significant differences in cerebral
palsy, infant mortality or other standard measures
of neonatal well-being. However, continuous EFM is
associated with an increase in cesarean sections and
instrumental vaginal births.9
BloomSpokane.org
EvidenceBasedBirth.com
ImprovingBirth.org
Patient Rooms
Triage
Some hospitals use triage rooms for initial labor
assessment and testing when patients first arrive.
After assessment, you will either be admitted to the
hospital or discharged with instructions on when to
call or return. Some triage areas are small and limit
the number of support people allowed to accompany patients.
Intermittent EFM: There is no evidence that intermittent monitoring with the electronic fetal monitor
is any better than continuous electronic monitoring. 9
Intermittent Auscultation: Based on the evidence,
the best option for most women and babies is intermittent auscultation. With this method, the care
provider listens to the baby’s heart rate for about
60 seconds using a fetal stethoscope (fetoscope or
Pinard) or a hand-held Doppler ultrasound device.9
Labor, Delivery, and Recovery (LDR)
In many hospitals, especially larger ones, LDR rooms
are where you will give birth and do your immediate
postpartum recovery. LDR rooms are equipped to
handle vaginal births, including those with epidurals
and other pain medications. Following birth you will
move to a postpartum room with your baby.
Midwives
According to Childbirth Connection, “Care by
certified nurse-midwives (CNMs) is generally
associated with a lower likelihood of using various
labor and birth interventions than maternity care
with doctors. Midwives are well-suited to care for
healthy women who expect to have a normal birth.
Many give priority to providing good information to
women, involving women in decision-making, and
providing flexible and responsive care.”10
Labor, Delivery, Recovery, Postpartum (LDRP)
LDRP rooms allow you to remain in one place for
your entire stay at the hospital, from admittance in
labor to discharge. You will give birth in this room
and your baby will stay with you until you are ready
to go home. As with the LDR, the LDRP is equipped
to handle only vaginal births.
Postpartum (PP)
After giving birth, the rest of your stay in the hospital will be spent in a Postpartum Room. In most
hospitals, rooming-in with baby is routine both day
and night. You and your newborn will receive care
from nurses as well as breastfeeding support.
Lactation Consultant (IBCLC)
During your hospital stay, you will receive breastfeeding assistance and support from an International
Board Certified Lactation Consultant. They work collaboratively with primary care providers and nurses
to assure appropriate clinical/practical management
of breastfeeding and lactation in order to protect,
promote, and support breastfeeding.
Routine IV Fluids
VBACFacts.com
ChildbirthConnection.org
TheUnnecesarean.com
Evidence-Based Care
Evidence-based maternity care
uses the best available research
on the safety and effectiveness of
specific practices to help guide
maternity care decisions and to
facilitate optimal outcomes in
mothers and newborns, while also
taking into account an individual
woman’s values.19
Patient-Centered Care
Patient-centered care supports
active involvement of patients
and their families in decision-making about individual options for
treatment.
The Institute of Medicine defines
patient-centered care as, “Providing care that is respectful of and
responsive to individual patient
preferences, needs, and values,
and ensuring that patient values
guide all clinical decisions.”20
According to Evidence Based Birth, “Among women who have unrestricted access to oral fluids, IV
hydration during labor offers only one advantage—
it may reduce the incidence of nausea/vomiting. It
does not have any other benefits. It does not shorten the length of labor. The risks are that IV hydration
during labor may lead to an artificially high drop in
the newborn’s weight, which can adversely affect
breastfeeding. The risks related to post-partum
edema and engorgement are unknown.”11
Neonatal Intensive Care Unit (NICU)
Level I: Well Newborn Care
These nurseries care for healthy, full-term babies.
They are able to stabilize babies born near term
to get them ready to transfer to facilities that offer
special care.
Level II: Specialty Newborn Care
Special care nurseries can care for babies born at
greater than 32 weeks gestation or who are moderately ill with problems that are expected to resolve
rapidly without urgent or sub-specialty care.
Saline Lock
The saline lock is a clamped off IV that is often used
for low-risk mothers in labor. It allows immediate access to the vein in the event of a complication, to
deliver IV pain medications like Nubain, Fentanyl,
etc., should the mother request epidural anesthesia, require a cesarean section (c-section) or have a
postpartum hemorrhage.
Level III: Neonatal Intensive Care
Level III NICUs care for the sickest babies and are
required to have pediatric surgeons. These nurseries care for babies born greater than 28 weeks. They
BLOOM SPOKANE HOSPITAL MATERNITY GUIDE 2014
Online Resources
5
DEFINITIONS & EVIDENCE FOR MATERNITY CARE PRACTICES
Evidence Based Birth says, “There is little-to-no
evidence for the use of a saline lock during an
un-medicated labor. However, there are risks and
benefits to having the saline lock. The ultimate
decision for whether or not to have a saline lock
should come from you.”12
Review the risks and benefits of a saline lock at
evidencebasedbirth.com.
Skin-to-Skin Care
Evidence Based Birth says, “Early skin-to-skin care
(also called kangaroo care) is a natural process that
involves placing a naked newborn chest down on
the mother’s bare chest and covering the infant with
blankets to keep it dry and warm. Ideally, skin-toskin care starts immediately after birth or shortly
after birth, with the baby remaining on the mom’s
chest until at least the end of the first breastfeeding
session.
The benefits of skin-to-skin care are so clear that the
World Health Organization recommends ALL newborns receive skin-to-skin care, no matter the baby’s weight, gestational age, birth setting, or clinical
condition. (WHO, 2003)”13
Skin-to-Skin Care After a Cesarean
“Research to-date demonstrates that ‘very early’
skin-to-skin care after a Cesarean is safe and beneficial. Evidence has shown that it is possible—and
best practice—for moms and babies to stay together after a Cesarean.
Mothers who want to do very early skin-to-skin
care and interact with their babies after a C-section
should talk with their providers about this. Moms
should also talk with their anesthesiologists to make
sure that they do not receive sedative drugs unless
medically necessary, as these drugs may make some
women incapable of early interaction with their
newborns.”14
planned vaginal delivery. No data support planned
cesarean for birthweight discordance alone.
Local Hospitals
Obstetricians need to be prepared for, and skilled
in, breech extraction of the second twin. Individualized patient counseling regarding mode of delivery
is important when offering a vaginal trial of labor to
women with a twin gestation.”16
Deaconess Medical Center
Vaginal Birth After Cesarean (VBAC)
Per the American College of Obstetricians and
Gynecologists, VBAC is a “safe and appropriate
choice for most women” with one prior cesarean
and for “some women” with two prior cesareans.
Being pregnant with twins, going over 40 weeks,
having an unknown or low vertical scar, or suspecting a “big baby” should not prevent a woman from
planning a VBAC.17
800 West Fifth Avenue
Spokane, WA 99204
Phone: (509) 473-7241
Kootenai Health
2003 Kootenai Health Way
Coeur d’Alene, ID 83814
Phone: (208) 666-2123
Providence Holy Family
5633 N Lidgerwood St
Spokane, WA 99208
Phone: (509) 482-BABY
More Information on VBAC: vbacfacts.com
Providence Sacred Heart
Medical Center
References
101 West 8th Ave.
Spokane, WA 99204
Phone: (509) 474-2400
1. Baby-Friendly USA, Inc. http://www.babyfriendlyusa.org/
2. Dekker R, “What is the Evidence for Pushing Positions?,” http://evidencebasedbirth.com/what-is-the-evidence-for-pushing-positions/
3. Cesareanrates.com. http://www.cesareanrates.com/about/
4. W. Lawrence Warner, MD, “Arriving at the Appropriate Cesarean Delivery Rate,”
ACOG District VIII Gazette (July 2013).
5. Dekker R, “The Evidence for Doulas,” http://evidencebasedbirth.com/the-evidence-for-doulas/
Valley Hospital
12606 E Mission Ave
Spokane Valley, WA 99216
Phone: (509) 473-5475
6. Sloan M, “Common Objections to Delayed Cord Clamping – What’s The
Evidence Say?,” Science & Sensibility, http://www.scienceandsensibility.
org/?p=5730
7. Washington State Hospital Association, www.wsha.org
8. Singata M, Tranmer J, Gyte GML. Restricting oral fluid and food intake during
labour. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.:
CD003930. DOI: 10.1002/14651858.CD003930.pub3.
9. Dekker R, “Evidence-Based Fetal Monitoring,” http://evidencebasedbirth.com/
evidence-based-fetal-monitoring/
10. Childbirth Connection, http://www.childbirthconnection.org/article.asp?ck=10163&ClickedLink=247&area=27
11. Dekker R, “Are IV Fluids Necessary during Labor?,” http://evidencebasedbirth.
com/are-iv-fluids-necessary-during-labor/
12. Dekker R, “Evidence for the Saline Lock during Labor,” http://evidencebasedbirth.com/the-saline-lock-during-labor/
13. Dekker R, “The Evidence for Skin-to-Skin Care after a Cesarean,” http://
evidencebasedbirth.com/the-evidence-for-skin-to-skin-care-after-a-cesarean/
Twin Births
The largest clinical trial ever on twin births found
that “twins don’t do better with planned cesarean
delivery than with planned vaginal birth when the
first baby is in a good position. Death or serious
neonatal morbidity occurred in 2% of cases either
way the birth was planned.”15
A 2011 review of evidence in Obstetrics & Gynecology found, “When the presenting twin is cephalic, evidence supports a vaginal trial of labor in
late preterm and term twins. Routes of delivery for
preterm twins lighter than 1500 g remains unclear,
with compelling data for both planned cesarean and
14. Dekker R, “Can Hospitals Keep Moms and Babies Together after a Cesarean?,”
http://evidencebasedbirth.com/can-hospitals-keep-moms-and-babies-together-after-a-cesarean/
15. Barrett J, et al. “The Twin Birth Study: a multicenter RCT of planned cesarean
section (CS) and planned vaginal birth (VB) for twin pregnancies 320 to 386/7
weeks” SMFM 2013.
16. Christopher D, et al. “An Evidence-Based Approach to Determining Route of
Delivery for Twin Gestations” Rev Obstet Gynecol. 2011; 4(3-4): 109–116.
17. American College of Obstetricians and Gynecologists. (2010). ACOG Practice
Bulletin No. 115: Vaginal Birth After Previous Cesarean Delivery. Washington DC.
18. Childbirth Connection. http://www.childbirthconnection.org/article.asp?ck=10081
19. Sakala M, et al. “Evidence-Based Maternity Care: What It Is and What It Can
Achieve” (October 2008).
20. Institute on Medicine. “Crossing the Quality Chasm: A New Health System for
the 21st Century”. Retrieved 26 November 2012.
OUR MISSION
Our mission is to improve the quality of maternity care in Spokane, WA by
providing information and resources to local childbearing families and health
care professionals. Bloom Spokane promotes Mother-Friendly maternity
care, encourages informed health care decisions, and strives to improve our
community’s birth culture.
Bloom Spokane is an official chapter of BirthNetwork
National, a 501c3 nonprofit organization.
Mailing Address: P.O. Box 21005, Spokane WA 99201
Email: [email protected]
Website: bloomspokane.org
DISCLAIMER
The information presented here is for
educational purposes only and is not
professional medical advice. Always consult
a health professional before acting on
anything influencing your health and
well-being, or that of any minors in your
care.