Donald Morrish

By Donald Morrish and Iffath A. Hoskins

Cesarean sections are the most commonly performed surgery in the USA. Changing policies and clinical information have resulted in improved outcomes for both mothers and babies. We describe evidence-based best practices for a multi-strategy approach to reduce cesarean section rates, increasing safety and success of vaginal births after cesarean section, decreasing complication rates in higher order cesarean sections, and accurate estimations of blood loss. In addition, we present a novel approach of utilizing venous lactate levels to identify the need for blood transfusions in the resuscitation of women with postpartum hemorrhage. Given that pregnancy is a life event, we describe increased self-reported stress levels in women during pregnancy and after the birth. In summary, adoption of the best practices outlined herein will greatly enhance the safe practice of cesarean sections.

Part of the book: Caesarean Section

By Donald Morrish and Iffath Abbasi Hoskins

Although induction of labor (IOL) has increased over the years, corresponding improvements in perinatal outcomes have not occurred. IOL may result in increased risks for mother and baby, due to factors like gestational age (GA), Bishop score of cervix, and the methods used. Failed IOL resulting in increased cesarean sections may be due to unripe cervix, inadequate Pitocin use, and incorrect patient choice. Medically indicated IOL does not require awaiting 39 weeks GA. Nonmedically indicated IOL prior to 39 weeks GA may result in neonatal morbidity. Patients at 39 weeks GA can be induced electively and need not await labor. Cervical ripening methods include vaginal, oral, or IV medications and can be administered as outpatients rather than in hospitals, in order to decrease financial and time constraints. Ethical issues regarding indications, GA, choice of agent, location of cervical ripening, and failed IOL can have an impact on healthcare resources.

Part of the book: Childbirth