美国国家公共电台 NPR Twin's Difficult Birth Put A Project Designed To Reduce C-Sections To The Test

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SCOTT SIMON, HOST:

Women in the United States are more likely to die from childbirth complications than in other developed countries, and the problem's getting worse. One way to stop the deaths is to do fewer C-sections. Martha Bebinger at WBUR in Boston visited a hospital where two women recently died after C-sections. Investigators¹ found no evidence of substandard care, but it spurred South Shore Hospital to make a big change.

MARTHA BEBINGER, BYLINE²: Melisa McDougall is propped³ up in bed, her blonde hair pulled into a neat bun, makeup⁴ still fresh, when her obstetrician drops in.

RUTH LEVESQUE: How are you? You're going to have babies today. Are you excited?

SHAUN MCDOUGALL: Yes. I can't wait.

BEBINGER: Dr. Ruth Levesque says babies because Melisa McDougall is having twins. The boy they've named Brady is head down, ready for a normal vaginal delivery. But brother Bryce is horizontal across the top of Melisa's uterus. That's one reason Melisa might need a C-section. And there's another, says Dr. Levesque - Melisa's last birth was by Cesarean.

LEVESQUE: She has a scar on her uterus, and we've talked about this before, that there's a risk of the uterus opening on that previous site, so there's a risk of uterine rupture⁵ - very rare but there's always a possibility.

BEBINGER: But McDougall, who's 37, wants vaginal deliveries for both boys.

MELISA MCDOUGALL: I just feel like it's better for the kids, better for the babies.

BEBINGER: C-sections can save lives, but they can also lead to blood loss and other severe complications. About half of C-sections are considered avoidable. That's why South Shore Hospital turned to a new system called the Team Birth Project. It's led by Dr. Neel Shah. He says that often during childbirth, it's pretty clear which moms are in active labor⁶ and poised⁷ for a vaginal delivery and which moms must have a C-section.

NEEL SHAH: And then there's this huge gray zone and actually everything about the Team Birth Project is about solving for the gray.

BEBINGER: To avoid unnecessary C-sections when what to do is not clear, this hospital has changed labor and delivery from start to finish. Women are not admitted until they're in active labor. Moms help guide the labor team, and they work together to map the delivery plan on a white board.

LEVESQUE: Should we fill out stuff on our board to make sure we're being thorough of things? Team - that's all of us.

BEBINGER: Dr. Levesque, Melisa, her husband, Shaun McDougall, and their nurses will update the board with Melisa's blood pressure, her medications and the baby's heart rates. Melisa, her labor and the babies are tracked as distinct moving parts during this delivery.

LEVESQUE: Melisa, specific things besides babies your chest, Shaun helping⁸ with delivery, other specific things that are important to you guys?

BEBINGER: Levesque writes it all down with a green marker.

LEVESQUE: So I'm going to write that - so skin to skin, epidural.

BEBINGER: Melisa's doctors insisted she get an epidural. She'll need the pain relief if they have to turn a twin inside her uterus or for a C-section. Seven hours into labor, after many conversations with the team and notes added and erased⁹ on the board, Melisa asks for that epidural.

UNIDENTIFIED PERSON #1: So we're in at 17:12.

BEBINGER: And less than an hour later, nurses rush her into an operating room to push.

LEVESQUE: OK. Are you ready? Grab this hand for me. Ready? Curl down. Push like heck.

BEBINGER: Bent¹⁰ nearly in half, her face beet¹¹ red, Melisa strains for five pushes. She throws up and gets right back to it. Then he's crowning.

S MCDOUGALL: Oh, my goodness, Brady.

BRADY MCDOUGALL: (Crying).

BEBINGER: Shaun steps back, weeping. Levesque reaches into Melisa's uterus for the second baby, but he's still sideways.

UNIDENTIFIED PERSON #2: That's a hand.

LEVESQUE: Yeah. All I got is hands.

BEBINGER: Dr. Terri Marino, a high-risk specialist who has more experience with transverse babies, asks to try. Levesque moves to Melisa's side and uses her forearm to push down. At least six doctors and nurses encircle Melisa. Shaun frowns.

S MCDOUGALL: Babe, are you OK? OK.

BEBINGER: Melisa nods, but there's still no sign of a foot.

LEVESQUE: Want me to hold it down?

TERRI MARINO: Open the table.

LEVESQUE: It's open.

UNIDENTIFIED PERSON #3: Can you see what I have?

BEBINGER: The table, meaning the array of surgical¹² instruments Marino will need for a C-section. Then Marino asks me to stop recording¹³ so she can focus and make one last attempt to avoid a C-section. For 30 seconds, the room is quiet while Dr. Marino twists her arm this way and that. Shaun bites his lip. Then there's Marino's gloved, bloodied¹⁴ hand clenching¹⁵ two teensy legs.

S MCDOUGALL: Oh, babe, here he comes. Here he comes, babe. Here he comes.

UNIDENTIFIED PERSON #4: Good boy.

BEBINGER: Outside the OR, Marino says most doctors would have delivered the second baby, Bryce, by C-section, but the McDougalls happened to choose a hospital committed to fewer C-sections and a doctor who could handle more challenging deliveries.

MARINO: They specifically wanted to have vaginal delivery of both babies.

BEBINGER: And are you thinking that in that moment...

MARINO: Yep.

BEBINGER: ...As you're searching for them?

MARINO: Absolutely.

BEBINGER: Bryce was fine, says Marino, so the deciding factor was that Shaun and Melisa did not panic.

MARINO: They did not flinch¹⁶. They were like, keep going, because sometimes patients say stop, and then you have - you stop.

BEBINGER: Shaun almost did, but he says that feeling that he and Melisa were part of the team made a difference.

S MCDOUGALL: I think it made us more comfortable, that we trusted the decisions that they were making.

UNIDENTIFIED PERSON #5: OK, hold on, hold on.

BEBINGER: Now, 30 minutes after this unusual birth, Melisa is nursing Brady and FaceTiming with the in-laws.

M MCDOUGALL: Hey, Pa.

UNIDENTIFIED PERSON #6: I'm proud of you.

M MCDOUGALL: Thank you.

UNIDENTIFIED PERSON #6: Good job. They're beautiful.

BEBINGER: South Shore Hospital began using the Team Birth approach in the spring and is on track to perform almost 50 fewer C-sections this year as compared to last. For NPR News, I'm Martha Bebinger in Boston.

(SOUNDBITE OF MAEVE GILCHRIST AND VIKTOR KRAUSS' "VIGNETTE")

SIMON: This story is part of a reporting partnership¹⁷ with NPR, WBUR, and Kaiser Health News.