Episode 046: Using Midwives to Lower the C/Section Rate with Dr. John LaGrand

For women, a very scary and anxious time of their life is pregnancy. With it comes excitement, fear, and all the physical and hormonal changes that add to the stress. Often at the top of all these concerns is how their day of labor and delivery will go and whether their child and body emerge from the other side without any complications. C/sections are a very common procedure in the US for women constituting 33% of all live births.

That c/section rate is fairly consistent across the country and is due to a number of factors. Some claim it is the litigious nature of our country, others say it is obesity, and even others think it is the a procedure of convenience for the obstetrician or even patient. However, my guest Dr. John LaGrand, believes it is because at their heart, all doctors are interventionists and due to a variety of factors will default to an intervention much earlier than is probably necessary. His private practice, in which he works collaboratively with four certified nurse midwives (CNMs), he believes is a different way to practice obstetrics and has led to a c/section rate of only 5%.

By allowing his CNMs the freedom to practice midwifery as they were trained he is able to focus his time on gynecological surgeries and the occasional forceps delivery or c/section when the labor takes a turn from routine. His practice has had 49 out of 50 successful vaginal deliveries after prior c/section and despite being a small percentage of total births in the large metropolitan hospital has still lowered their overall c/section rate by a few percent.

Dr. LaGrand tells his pregnant patients that their pregnancy and labor will be like climbing a mountain and the CNMs are the guides. They will assist the patients in their journey up the precipice and usually get them their safely. However, if something happens and they can't go any further, his guides will call the helicopter to rescue them off the side of the mountain - he is the helicopter and will only come if absolutely necessary. By setting up his practice to let the midwives practice their craft and him to be a true backup without interference he believes leads to such dramatic results.

We also learn in this episode about how he grew up in Halifax, Canada and went to school with Sarah McLachlan. She's kind of a big deal. Certainly a bigger deal than either of us.