Bringing back the ‘VBAC’
How Enloe helped mothers achieve natural birth
CHICO >> After two decades, obstetricians at Enloe Medical Center were honored for their work openly supporting mothers hoping to give birth vaginally after a cesarean section.
Enloe Medical Center gave a special internal award to Nettleton Mother and Baby Care Center doctors at the annual summit, conducted virtually open to the public for the first time Tuesday.
Chief Medical Officer Dr. Marcia Nelson said the summit, celebrated internally since 2009, is taking place in public to exemplify celebrating the work of the hospital.
“We share our quality improvement journeys, where we started and how we continue improving,” she said. One of those is celebrating the work of the women’s services department, with success stories beginning in 2019 as doctors were allowed to support and encourage mothers wanting to deliver vaginally after a C- section birth.
Obstetrician Dr. Raleigh Unterseher of the center had tirelessly advocated for supporting the “TOLAC” — trial labor after a C-section — and “VBAC” — successful post- cesarean vaginal birth — services from 2002-2003. After the policy was turned down, he said obstetricians were told not to offer patients the TOLAC process and related services.
But in the last decade, medical best practices turned to wanting to reduce C- sections, which led to more research on guidelines for TOLAC births, and ultimately “bringing back the VBAC” at long last in 2019, he said. It enables them to have more choices in their hands for birth.
“The decision is made between the doctor and the patient like it always should be, not (in) institutional policy that shuts the door and takes away options,” Unterseher said.
Statewide, success rate of the VBAC process was just over 50% in 2019, but at Enloe, it was 71% that year, and jumped to about 76% in 2020. Unterseher said his staff also benefits from having midwives from Paradise after the Camp Fire. He said he is proud to practice in California where experts are “leading the nation” in making it safer to give birth.
A mother’s triumph
Kacie Holt said her first birth in 2019 was “super traumatic” as it ended in an emergency C- section “which was really hard on me physically, mentally and emotionally. But her Enloe physician encouraged her to consider a VBAC.
“Having a natural birth is so important to me emotionally and physically,” Holt said, and she was determined to achieve this goal without another lengthy, devastating recovery. So she prepared by doing lots of research on different risks like uterine rupture. She said her doctor was always “super supportive — they never went back on it, never tried to force me into another Csection.”
“My first labor, everything was just happening to me and I was not an active participant.” She said this time she felt in control and entirely supported by nurses who studied as doulas and even staff who had also had successful VBAC births.
“They were so encouraging and getting me positive affirmations,” she said.
“I couldn’t have asked for a better experience with these women … helping me achieve this thing I have wanted literally my whole life. “
Holt said she is not sure if she will have more children, but if she did, she said she would go back to Enloe again.
“They definitely have your best interests in mind and want you to have the safest and best delivery,” she saud. “A laboring woman needs to feel safe … and they give you a lot of positivity.”
Other work
Nelson also highlighted increased accomplishments towards addressing high opioid use in the county with the substance use navigator program. She said 72% enrolled continued in the free program, six months after enrollment.
“We’ve seen Butte County opioid deaths decrease after recent months,” Nelson said.
And, she said Enloe is working on “Creating community and bringing everybody together so we can fight this COVID pandemic together,” with local partners as support.
“Our partnership with Butte County Public Health has never been stronger,” she said.
Nelson said the summit is as a way to “be accountable to ourselves and to our patients.”
Enloe Medical Center was also recognized Tuesday with Healthgrades’ 2021 Patient Safety Excellence Award. The distinction places Enloe among the top 5% of all short-term acute care hospitals reporting patient safety data as evaluated by Healthgrades, a marketplace connecting patients and providers.
Mike Wiltermood, Enloe’s president and CEO, said “This award placing us among the nation’s safest acute care hospitals is a reflection of our caregivers’ dedication to excellence in a time when we’ve seen just how vital quality health care is to our communities.”