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Where did you \ufffcreceive your schooling and training?<\/strong> How long have you been in practice?<\/strong> Did you specialize in a particular area of obstetrics-gynecology?<\/strong> What got you interested in obstetrics and gynecology?<\/strong> How have the medical world\u2019s views on Caesarean sections as a common birthing option changed over time?<\/strong> As technology developed, there was an invention called the fetal heart monitor. In the hospital, we started monitoring babies during labor and delivery. We realized that when the baby\u2019s heart rate drops, that may be a sign of distress. We would then stop the attempt at a vaginal delivery in these cases and proceed with a C-section. As a result, the C-section rate grew. Then once you had a C-section, it was recommended that you have C-sections after that.<\/p>\n As time went on, we did more research and realized C-sections actually involve a lot of risks, more so than having a vaginal delivery. If you attempt to have a vaginal delivery after a C-section, it can be a relatively low-risk option compared to having another C-section. We began offering vaginal births after Caesarean sections, and we started to see C-section rates decline. We\u2019re always trying to balance these risks and benefits for babies and their mothers.<\/p>\n Certified Nurse Midwife Bonny Hinz listening to Olivia Rosales’ heartbeat What risks do C-sections present?<\/strong> When are C-sections warranted?<\/strong> So, vaginal delivery is the way to go, but with option of a C-section if needed?<\/strong> Since then, we\u2019ve seen such a great turnaround in how satisfied our new moms are with their delivery experience, because the nurse-midwives are great at coaching them on how to push and breathe. They have them labor in different positions and suggest different techniques that can greatly improve their comfort. It\u2019s made a world of difference having them here.<\/p>\n After bringing in our nurse-mid-wives, we found that our C-section rate went down as well. We became even more mindful about letting the labor progress at its own pace, including trying different positions for labor and pushing. Their patience and understanding of labor and delivery have not only made the experience of our new moms better, but safer.<\/p>\n Do you actively educate women about keeping the C-section rate down?
\nI went to University of Hawaii\u2019s John A. Burns School of Medicine and I also trained at UH for my ob-gyn residency.<\/p>\n
\nI initially did five years in a group practice. I joined Kaiser Permanente in 2000, so I\u2019ve been here now for about 15 years. I\u2019m chief of Kaiser\u2019s Koolau Medical Office and Windward Section chief of ob-gyn.<\/p>\n
\nI\u2019m a generalist, so I cover the entire field, which includes medical, surgical and preventative care for the female reproductive system and related disorders, as well as managing pregnancy, labor and delivery.<\/p>\n
\nWhen you\u2019re a medical student, you rotate through different specialties, which is good, because you figure out what interests you. I didn\u2019t think that I would be interested in being an ob-gyn, until I rotated through the practice and did my very first delivery. I\u2019ll never forget it, because as soon as the baby was born and I was standing there with the baby in my hands, I thought, \u201cThis is it. This is what I was born to do.\u201d I was nearly in tears. The whole experience was so powerful.<\/p>\n
\nBirths were once done at home by midwives. People didn\u2019t go to hospitals to have their babies. Back then, maternity morbidity rates from pregnancy were quite high, and the leading cause of death for a woman of child-bearing age was labor and delivery. Once hospital care became more prevalent and deliveries moved into hospitals, maternal morbidity rates started to decrease.<\/p>\n![\"Certified](\"https:\/\/hawaii.carpentermediagroup.com\/midweekpro\/wp-content\/uploads\/sites\/12\/2015\/06\/Screen-Shot-2015-06-06-at-11.37.39-PM-e1433670238172.png\")
NATHALIE WALKER PHOTOS<\/b><\/p><\/div>\n
\nThese days most people think of C-sections as a minor procedure, but it\u2019s actually a major abdominal procedure. There is an increased risk of infection and bleeding. In some cases, the bleeding can lead to the need for a hysterectomy. You also can get scar tissue from the surgery. If you require anesthesia for the C-section, there are risks with that. If you\u2019ve had a prior C-section, with future pregnancies the scar tissue could cause the placenta to attach to the uterus in a potentially dangerous way. Definitely, if we can avoid a C-section, that is best.<\/p>\n
\nC-sections are valuable in certain cases, such as when the baby is in distress. If the baby is not \u201cpresenting\u201d well, say, if the hands come out first, C-section is the way to go. If you\u2019re having more than one baby at the same time (twins, triplets), a C-section may be recommended depending on the babies\u2019 positions, how many there are, and if there are any other complications. C-section may be recommended for certain infections or prior surgical histories. The last consideration is if the mother\u2019s labor is not progressing well or if the baby is too large.<\/p>\n
\nAt Kaiser Permanente, we do collaborative care with our nurse-midwives, who are certified nurse practitioners that also have completed midwifery school, so that they can provide pre-natal care as well as labor and delivery care. We wanted to give our patients the best experience in labor, so we brought midwives into the practice about six years ago.<\/p>\n
\nWe do. Even while they\u2019re in labor, we say, \u201cYou\u2019re not progressing, but we can give it more time because the baby looks OK.\u201d In the old days, after two hours with no change, we\u2019d do a C-section. But we now know from experience that it\u2019s OK for a laboring woman to take her time.<\/p>\n