Season 6 Episode 7: Safely Preventing Primary (NTSV) Cesarean Delivery—A Conversation with David C. Lagrew Jr. M.D.

InCast

Listen in as we discuss promoting Vaginal Nulliparous Term Singleton Vertex (NTSV) birth to decrease the risk of maternal morbidity and mortality. Dr. Lagrew agrees with a past president of the Society for Maternal-Fetal Medicine, Vincenzo Berghella, who said, “Physicians do need to balance risks and benefits, and for some clinical conditions, cesarean is definitely the best mode of delivery. But for most (NTSV) pregnancies that are low risk, a cesarean delivery may pose greater risk than vaginal delivery, especially risks related to future pregnancies.” Working to decrease the number of cesareans that are not strictly for clinical conditions is something we can all work on. Educators, nurses, community health workers, and others can use the information Dr. Lagrew shares to help people avoid the first cesarean. This will not only lower unintended outcomes of the initial cesarean like hemorrhage and infection but also prevent problems in subsequent pregnancies.

Dr. Lagrew is a maternal-fetal medicine specialist and physician informaticist with a particular interest in maternal quality improvement. He recently retired as Medical Director of Women’s and Children’s services for Providence St. Joseph-Southern California and as a Providence System Provider Informaticist in Obstetrics. He has started his new role as Chief of Service, Maternal Fetal Medicine at Hoag Healthcare. He holds triple board certification in Obstetrics/Gynecology, Maternal Fetal Medicine, and Clinical Informatics. In addition to these administrative and leadership roles, he continues to actively author numerous peer-reviewed publications and book chapters. He is a clinical professor in the Department of Obstetrics and Gynecology at UC Irvine. He is the immediate past chair of the Society of Maternal-Fetal Medicine’s Clinical Informatics Committee.

Listen and Learn: 

• That the absolute lowest risk delivery is a vaginal delivery after a previous vaginal delivery
• The rate of cesarean birth compared to vaginal births in the US now
• How an NTSV protects the woman’s long-term health, especially if she plans to have more children
• How midwives may have a lower cesarean rate due to their practice of admitting to the hospital later during labor
• How the shared decisions help prevent primary cesarean births
• How having a wide range of cesarean rates, state by state, is actually a good thing
• A sneak preview of the US’s ARRIVE Study compared to an upcoming study out of Canada
• That robust childbirth education about risks and benefits including an explanation of complications and outcomes will benefit parents and will likely decrease the cesarean rate

Resources & Mentions: 

• Nation’s Ob-Gyns Take Aim at Preventing Cesareans
• Safe Prevention of the Primary Cesarean Delivery
• Childbirth Connection info on cesarean resources
• California Maternal Quality Care Collaborative (many states have similar organizations)
• Email Dr. David Lagrew: [e-mail]

Related Products from InJoy: 

• Understanding Pregnancy
• Understanding Birth
• The Stages of Labor