HJAR Mar/Apr 2024

HEALTHCARE JOURNAL OF ARKANSAS I  MAR / APR 2024 23 pregnancy that would warrant the need to deliver that baby earlier because the environ- ment inside that uterus is no longer a benefit to that baby, so we need to get that baby out. We've learned this over the years. Our data, our research, all these things that we’ve done have given us all this additional information that we didn't have 15, 20, 30 years ago. However, their cervix may disagree with us. So, though we feel as a medical commu- nity that baby may need to come out due to the diagnosis or no longer being an adequate home for that baby, if that cervix is unfavor- able andwe plan an induction to get that baby out, we know that momnowhas an increased risk of getting a C-section. In an ideal world, everyone would go into labor on their own when it's appropriate for their baby and have a fabulous baby andmomoutcome, but that's not where we live. I'd also be remiss not to say that we live in a medically legally litigious world, and Arkansas is not terrible with regard to that. We interview people from around the coun- try and in places like New York and some of the other northeastern places, residents don't graduate without at least a couple of lawsuits with regard to things that have happened in delivery. We want perfect outcomes, but sometimes patients have healthcare concerns that change that plan of care fromwhat their ideal is. It is a navigation process, and hav- ing that physician and that patient discuss what that looks like early and frequently is what gets both parties on the same page. We just knowmore now. We knowwhat's unsafe, and sometimes we're forced to deliver earlier than that babymay have necessarily wanted, therefore inducing themand increasing that risk of a C-section. Talking about what we've learned, doctors have, not too long ago, been criticized for planning C-sections around their schedules. How has that improved? Are you still seeing outliers in that case, or is that still common? That's a little bit loaded because places such as UAMS have people here 24 hours a day, seven days a week. We have the luxury of having anesthesia here all night long, 24 hours, seven days a week. Some of the rural communities may not have access to anes- thesia 24/7. They may have to call someone in and know that that standard of care is 30 minutes to get that provider or physician in there. Theymay potentially see a strip that is questionable that they could potentially sit on and just see what happens. But the con- sequence of if that baby crashes, and there aren’t these people there, are significantly worse than preemptively being safer. I hear this a lot from the rural commu- nity, and I want to defend them. I don't think Cesarean Delivery Rate by State Source: National Center for Health Statistics, Centers for Disease Control and Prevention.“Cesarean Delivery Rate by State.” Last reviewed Feb. 25, 2022. https://www.cdc.gov/nchs/pressroom/sosmap/cesarean_births/cesareans.htm