FORT BENNING, Ga., (Oct. 19, 2016) -- The Martin Army Community Hospital Women's Health Clinic provides numerous invaluable services to ensure the proper health and wellness of women within the Fort Benning Community. Two particular services are increasing in popularity with expectant mothers. They are skin-to-skin contact, and hydrotherapy.

According to Maj. Sarah Ohm, chief, Midwifery Services at MACH, the services are not only a matter of patient satisfaction and a choice for the expectant mothers who are being seen at the hospital, but they are also a matter of quality improvement and safety.

"The first thing we're initiating is skin-to-skin in the operating room. This includes skin-to-skin contact between the mother and her newborn baby following cesarean delivery," Ohm said. "This is rather new, but it's based on a lot of evidence that initiating skin-to-skin immediately after delivery not only helps with transition of the neonate, as far a thermal regulation, long-term establishment of breast-feeding and vital sign regulation. It also helps with bonding between mother and baby and pain perception and regulation with the mother."

Ohm credits Maj. Courtney Folderauer, chief nurse of Women and Newborn care, with working extensively to establish a safe standard operating procedure and guidelines for the OR, for mom's who need eligibility criteria immediately after the baby is born, they can begin skin-to-skin.

According to Dr. Braden, chief, Dept. of Women's Health, they have been conducting skin-to-skin therapy for about a year for vaginal deliveries, but she said they had not being doing it for C-sections until recently. She said now, as long as the mother meets the criteria, they are conducting skin-to-skin whenever possible for women who deliver vaginally.

"As far as eligibility criteria for C-section, generally, anesthesia has to be on board and we make sure that mom is not having any issues or not in distress and that she doesn't have any other medical problems that they need to control at that time," Braden explained.

She said as long as the mother and baby are stable, they will try to initiate skin-to-skin contact across the board.

"It's definitely a team effort between the mother, anesthesia, the provider, and the pediatric department," Folderauer explained. "Peds plays a big part in that too, in making sure that the baby is stable enough to go to mom, as well."

Ohm said they encourage skin-to-skin, not only for the medical benefits, but patient satisfaction is a real issue, as well.

"Not many of these women here were anticipating surgical delivery, and were likely anticipating having skin-to-skin with their newborn in the delivery room. This is our way for us to return to them some of their ideas for their birth experience and to help increase the total satisfaction of that experience, because how they perceive their birth experience is just as important as the medical outcome," she said.

Ohm said they will also offer hydrotherapy to some expectant mothers for pain management and labor.

"We have a beautiful tub in labor and delivery room #5, and these are going to be for mothers who wish to use water immersion to help manage their pain," she explained. "This is obviously for women who are not receiving an epidural or IV medications. They need to meet criteria for having an uncomplicated labor," she said.

Ohm explained that some of the benefits of hydrotherapy includes: quickening the first stage of labor, reducing the need for anesthesia; decreasing the amount of blood loss, and increasing the satisfaction the women, have concerning their labor experience.

She continued, adding that there is also a prerequisite that the women must meet to be considered for hydrotherapy.

"We have a consent form that must be signed by the patient, but they do have to meet the criteria," she said.
"One, they can't have signs of infection, they cannot have requested IV or epidural anesthesia, they need to have a birth attendant who is willing to stay with them continuously, as our nursing staff is not able to be in the room with them at all times. Basically, it has to be considered a low-risk birth before they can be considered for hydrotherapy.

"Hydrotherapy is a tool that's used during active labor. Although women can request to use water immersion early in labor, it's not disallowed, but it is discouraged because it can slow down the labor process," Ohm said. "But once a woman has entered into the active labor phase, basically dilating about 5 cm, with regular painful contractions, she can elect for water immersion."

She said the duration depends on the length of the labor process, but typically, it lasts a couple of hours.

Folderauer was quick to point out the difference between hydrotherapy and water births.

"Hydrotherapy is for pain control and for patient satisfaction, but it is not for water births. We do not do water births here at Martin Army Community Hospital, or anywhere in the Department of Defense" she said.

"This aligns with the American College of Obstetricians and Gynecologists' guidance, that stated within the last year that water births should be limited to investigational use, which includes studies on water births. We are not doing a study, so for that reason, it has not proven to be safe," said Braden.

She said it is important to note that they do not deliver in the tub, so that there is no speculation from mothers who expect to deliver soon.

Additional information can be found by scheduling an appointment to visit the MACH Women's Health Clinic.