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crissrn27 6,546 Views

Joined Feb 21, '07. Posts: 1,024 (14% Liked) Likes: 340

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  • Nov 26 '11

    Quote from SJerseygrle
    I think it's fine and healthy that they are eliminating early C-sections but i think moms should be allowed a choice even if it's "only" for their convience. People have the right to try and have the life/birth/pregnancy they want to have. Life is hard enough without us judging other people for their choices.
    I am sure both sides have a ton of anecdotal stories about the negatives to each method but until the do actual studies which show signifigant harm to the baby due to non-premature elective c-sections vs. vaginal births no one has a leg to stand on.
    This is just another way to get women to fight amongst themselves so they can try and mandate other women's lives based on their own experiences and opinions.
    Can't the moms who are so wonderful just content themselves with their own (and their child's) superiority instead of trying to mandate everyone else's life?
    I don't want it to feel like everyone's jumping on you, but as Miranda said, there is plenty of evidence to show that c/sections aren't, generally speaking, the best thing for babies or moms. There is a reason that a NICU/peds team goes to every c/section at my hospital and not every vaginal delivery. (Read the NICU and Ob/Gyn forums around here and it sounds like a pretty set standard across the country.) Infants born via c/section are more likely to be admitted to a NICU, have respiratory distress, and have feeding issues. Even without the risks to the mom attendant with major abdominal surgery, the risks to the infant alone should be reason enough to keep away. As a nursery nurse, if L&D calls and says they're bringing a baby from a c/section, I get ready to hear some junky lungs, I automatically turn on the warmer closest to the pulse ox and get my O2 set up because I often end up needing one or both. It happens that much. This has nothing to do with being superior to anyone and everything to do with the health of newborns, which should always trump convenience. I'm not out to tear anyone down for what's already been done, because being a mom is hard.....but when the evidence is clear that c/section babies are at that much risk vs. a NSVD, I don't really get the heated argument.

    NO ONE here is saying that c/sections that are actually done to save someone's life are bad. Goodness knows I have been taken care of some patients who would clearly have lost their own or their babies' lives without one. But that's not quite the same as waking up one day and deciding you're finished being pregnant.

  • Nov 26 '11

    Quote from Kewpie Doll
    I had 2 elective c sections. They are great and I would do it again. One of the problems with the bad sentiments and statistics against elective c sections is that there is not good and conclusive data on elective c sections vs. c sections performed under conditions of duress and/or trauma. An elective c section is performed under ideal conditions - in a state absent of or before the advent of duress/trauma. The patient is in peak condition and the procedure is fast. That data of such c- sections is shunted into the same catagory with duress c-sections so the results are skewed showing mortality and morbidity that are likely due to the poor conditions of the other procedures.

    In my case conditions and outcomes were ideal. I don't feel I missed out on any part of motherhood. After birth I felt in good shape to enjoy my new baby and as an added bonus, I did not suffer any vaginal trauma, cutting, or perforations that 3 of my close friends had to go for follow up surgeries (and in one case more than a year of embarrasing issues.) I've read one expert who is pro elective C section because of all the, urine and fecal incontinence, prolapse and pelvic floor disorders he sees in his practice in later years due to vaginal births. Many of the complications of vaginal births are not readily revealed by sufferers due to embarrassment, and are not typically seen by the gynecologists who deliver the babies so the connection is not readily observed, reported and known to the public.
    Women arriving at the hospital for routine childbirth are also typically in "ideal" condition and their bodies are typically well-prepared to perform the function of labor and childbirth. Complications you mention such as cervical or vaginal trauma are rare. If you know of a physician with an unusually high number of patients complaining of these complications, perhaps it is his/her practices that should be examined. Pelvic floor disorders are more related to pregnancy itself than vaginal delivery, as well as aging, so patients are not likely to be spared this complication later in life by subjecting themselves to unnecessary surgery.

    I'm glad that you did not experience any complications as a result of your C-sections. When they occur, they are miserable to deal with, and I wouldn't wish them on my worst enemy. In 12 years of OB nursing, I can't recall a single mom who suffered extensive pelvic, cervical or vaginal trauma, but I can recall dozens, if not more, women with the following complications: Anesthesia problems ranging from ineffective anesthesia, severe hypotension, oral and dental trauma due to intubation (in a patient with an elective C-section who insisted on general anesthesia. She knew she had abnormalities of her palate and mouth, but didn't reveal that to the anesthesiologist because she was afraid it would disqualify her from general anesthesia. Darn right it would have. She woke up with oral trauma wishing she'd spoken up.), and a mom who broke her leg getting OOB by herself against orders because she felt so darn good after her elective C-section with spinal anesthesia. Not to mention those pesky spinal headaches and the severe itching so many women experience with Duramorph.

    On to other complications, including hemorrhage (saw one uterine artery inadvertently severed), infection, paralytic ileus, a bladder inadvertently nicked by a surgical instrument. Mom went home with a Foley for several months. And then there's the poor gal who contracted c-diff as a result of her "routine" antibiotics. This was almost 20 years ago, before it was widespread.

    As horrific as these complications are, they pale in comparison to the suffering of newborns thrust into the world too early and without the benefit of the transition provided by labor and passage thru the birth canal. We can debate all day whether purely elective C-sections should be performed, but there is no denying that there is (in the absence of medical contra-indications) physiologic benefits to the infant of passage thru the vagina on the way into this world, including preparation of the cardiovascular and respiratory systems to transition to extra-uterine functioning and colonization of the gut with normal flora.

    I suspect that the "expert" pushing purelely elective C-sections is more interested in his 9-5 M-F work schedule than his patients' and their infants' well being.

  • Nov 26 '11

    Quote from CrazierThanYou
    Optional, chosen, not necessary, any time vaginal birth is possible but not chosen... It's now being called "patient choice cesarean". The biggest problem here being elective c-section before the baby has a chance to reach full term.
    This terminology only contributes to the problem. "Patient choice" C-section fails to acknowledge that the physician is complicit in conducting unnecessary surgery. It's not like Mom can do a C-section on herself.

    Any C-section, at any gestational age, without a legitimate medical need is a problem, placing mother and baby at unnecessary risk for complications and contributing to needless health care costs that we all pay.

  • Nov 26 '11

    They're not banning them altogether, which would be nice too, just the ones before 39 weeks. I'm almost certain it's to do with the March of Dimes initiative, which is not brand new. When I was pregnant with DD (now almost 6mo old) my OB handed me a MoD pamphlet that basically said - unless there is a true medical need, we are not going to deliver you by any fashion before 39 weeks, so don't bother asking. I am glad to see this, because your average lay person doesn't realize the tremendous amount of fetal brain growth/development that occurs between 35 and 39 weeks.

    I had a patient a few months ago who was set to be induced at 34 weeks (PPROM on long term bedrest) who was genuinely shocked that her baby would end up in NICU for more than a couple days.

    This quote at the end was what galled me the most:

    "You're already out of control of your body, so at least to know if you go to your doctor's office and say, 'Look, we're at 37 weeks, and I feel like I'm ready,' " Lisa Coulouris, who had twins via emergency C-section earlier this year, told NPR. "To know that I would have that choice would just make me feel better. But to take it away from me just adds to the pressure of being pregnant.
    "I feel like I'm ready?" You might feel like you're ready, but your babies likely aren't, or they'd be letting you know. Taking the choice of induction/section away from you would add to the pressure of being pregnant? Come on. I know those last few weeks are uncomfortable, but that's part of the bargain. You don't get to have your baby delivered just because you feel like you are ready. Or, you shouldn't anyway.

    Sorry for the soapbox rant. I am just of the opinion, having seen it too many times, that if you push Mother Nature enough, she will eventually push back, and hard.

  • Nov 6 '11

    I would never recommend my friends have an induction, far from it actually. It just begins the cascade of medical interventions.

  • Nov 6 '11

    Inductions for non-medical reasons are way too common and involve many risks. It is amazing that adult women who have conceived a baby in the privacy of their bedroom are dictated to in regard to how to deliver that baby; and it is accepted as normal by the public and medical professionals alike.

  • Nov 6 '11

    I'm not an OB nurse, but as a mom who has had both an induction and a natural delivery (this past week) I did want to weight in on the subject. I had several other friends who were also pregnant and delivered within the last couple months. Out of the 5 of us 4 had c-sections. While I understand that there are many medical reasons that require c-section it seemed like an awfully high percentage that 80% required a c-section. As soon as I hit 38-39 weeks everyone began asking me when my "doctor" was going to induce me. Whether it was because my baby was measuring LGA or because I was nearing my due date I had to reassure my friends and family that this did not require an induction. My family was extremely concerned that I was going to have a midwife as my attending and that there was not going to be a doctor in the room. They also told me "take everything they will give you" in regards to medications after I had made the decision to try natural childbirth known.

    My induction was a horrible experience, especially as a first time mom. I was in "labor" for 48 hours, ended up with AROM and an epidural and as such pushed for another 4 hours. My induction was minutes from ending in a c-section. My son had to be in the NICU for 5 days (although as I was induced for medical reasons I can not say this was a direct result of the induction, although I do believe as he was having late decels he was 'stressed' by the prolonged labor). I ended up feeling completely not in control of my labor or of my first son. My natural childbirth on the other hand was entirely the opposite experience. I felt incredibly empowered and felt confident that this was what my body was meant to do and could do it without intervention.

    I feel that labor and delivery is probably the only time healthy people come to the hospital and they should be treated as such with as few interventions as neccessary to ensure a good outcome for mom and baby. As a friend I would encourage "Annabeth" to research all her options including the incidence of c-section with unnecessary induction of a first-time mom.

  • Nov 2 '11

    One of my most horrifying, made my face beet red moments:

    I dropped off some pain medication for a pt who was in the middle of OT, and I brought along her po nystatin since it was due. I said "your med book doesn't specify on your Nystatin swish, do you usually spit or swallow?" I stopped dead in my tracks, hoping the patient didn't notice my big boo boo... but she said with a huge grin "OHH I ALWAYS swallow!!!" my face was red for an hour after that! And of course I had to have a witness too!

  • Sep 23 '10

    I'm in grad school for 6 credits this semester, have pets at home and usually schedule the rest of my life around my work schedule. Is there something wrong with me?
    Don't ever for a moment think that putting your private life first is wrong.

    Ever!

  • Sep 23 '10

    I wouldn't call this common sense at all. I'm offended by your use of the Bible in this conspiracy theory you have, and that you are arrogant enough to think that somehow you know whether or not a person is in pain. I can guarantee you wouldn't be able to recognize it in me, even if I was really uncomfortable, and if you were my nurse and documented a 4 when I told you it was an 8, I'd be talking to your bosses in no time. I thought nursing was about patient centered compassion (what you call pill-pushing), not deciding that your patients are addicts too stupid to understand the pain scale.

    My least favorite part of this article:
    "We believe we are professionals but we do not know much about medications we give to our patients. It is even not our fault because nursing textbooks do not say anything about it. Probably because they do not want us to know the truth. They just want us to be pill pushers."
    Apparently, you slept through nursing school, because I can guarantee you that your teachers never ONCE told you to just shovel meds into your patients without understanding what you were giving them. As a practicing nurse, I find it disgusting that you weren't aware that opioids can cause constipation. I knew that before I even entered nursing school because it was beaten into our heads during pharmacology class! The rest of the RNs in the US don't need to go to Europe to figure that out because we actually paid attention in school, and know how to use a drug book now and then.

    Also, why don't you try proofreading your articles before posting them? I can understand a few mistakes here and there, but an article laced with obvious spelling and grammatical errors does not belong here. If you're not a native English speaker, have someone help you with your writing, so your article is easy to read. If we took the time to read this drivel, you should at least take the time to write it in a convincing manner.

    Sincerely,
    A Brainwashed Pill-Pusher

    P.S. This post is most likely going to get deleted, since I'm being pretty harsh, but I want to post it, anyway. I think OP needs to think about his biased opinions more deeply, or at least hide them from plain sight. I hate to think that both of us are considered nurses, because I don't want to share my profession with people who have this sort of attitude.

  • Sep 23 '10

    You have posted so many generalizations in this article that I am finding it hard to take the information seriously.

    Charges of wholesale brainwashing and referring to medical folks as pill pushers does little to earn credibility.

    I also take issue with this statement:

    Let’s have a look at my patient who had “a little bit of pain” and rated it 8. I handle this situation according to common sense. I documented “4” and did not offer pain med.
    It is dead wrong to change the patient's pain rating to the number you think it should be. AND it is wrong to ignore even a rating of 4. You can add information to your charting (what the patient was doing that suggests a lower pain level, for example), but you can't just outright pull a number out of the air. That pain rating is the patient's perception, not yours.

    A pain rating of 4 requires some kind of intervention. It doesn't always have to be pharmaceutical, but if repositioning and ice and relaxation and other measures don't work within an hour, you need to give the ordered meds.
    Pain shock kills, so pain 10/10 kills. But our body has a protective mechanism. When you are in severe pain you may loose conscious. So if you lose conscious but still alive it means toy pain level is 9/10
    It seems like you are saying that if someone truly had pain of 10/10, the shock of it would kill them. If it only renders them unconscious, they can be a 9/10, but nobody reaches 10/10 alive. This shows a serious lack of knowledge.

    To make a story short, only few category of patients need narcotics to control pain. They are: cancer patients, patients with gun shot wounds, some (not all) post op patients.
    Wow! I would venture to guess that you have never had a kidney or gallbladder stone. I'd be curious to find out what kinds of surgery you think do not merit post op pain meds. Should I tell my c-section moms they should just be satisfied with ibuprofen? How about kids in sickle cell crisis? Is that painful enough to deserve medication? Vasculitis? Pinched nerves? Burns?

    You express great fear about patients developing opioid addiction. Yes, it's true that some chronic pain sufferers can become dependent on narcotics to be able to function, but people who are genuinely in pain metabolize pain meds differently from those who are using recreationally. It's also true that some people stay on narcotics longer than they should and change from needing the meds to simply enjoying them. But it seems rather drastic to address that possibility by withholding meds from the get-go.

    As I said, I can empathize with your concern, but if you are a nurse, I fear you are short-changing your patients by judging them and making decisions based on a very limited (and distorted) understanding of pain pathophysiology and treatment.

    Sorry, but I do not find this a sensible approach at all.

  • Aug 11 '10

    Grandmawrinkle was a bad girl today. Was in charge (ICU), they floated away one of my nurses away for the afternoon. The radiology suite calls saying that they need to give report and drop off a patient NOW that we were not expecting for another 3-4 hours (after change of shift, when we would have had a nurse to take him.) I declined (they only would have had to hold the patient for 1/2 hour.) She gets her NM on the phone. She gives me a raft of s#$%. She asked to speak to my supervisor. I told her she wasn't on the floor (which was true, she was off elsewhere doing something.) She got really aggressive and said she needed the patient up in the ICU immediately (not true, routine procedure, stable patient.) I told her that I would call the nursing office and see if I could get my nurse back that I floated, but until then she could not bring up the patient ....

    unless I could pull a nurse out of my butt.

    She told me I was unprofessional. I suppose I was. She told my boss . I got reprimanded (with a smirk.) We really couldn't take another patient without another nurse, and she knew it.

    I really try hard not to say that kind of stuff, but 1 time out of 100 something like that flies out of my mouth if my buttons get pushed.

    Whoops!

  • Jul 23 '10

    Also, in the cases where I know of hospitals that did not "allow" TOLAC, most often, it was because there was an unwillingness to provide IN HOUSE, OB- dedicated 24/7 anesthesia coverage for the case of an emergency. I find that wrong.

  • Jul 23 '10

    BUT c/s is not automatically "safer" and, honestly, the ONLY uterine rupture I saw (knock wood) was on an UNSCARRED primiparous uterus! I think so many of our problems stem from an inappropriate use and number of inductions of labor. If we did not push so hard, there would very likely be fewer "failure to progress" cases ending in c/s ! I honestly think we are the cause, not the cure, oftentimes, for the many complications that arise for laboring women.

  • Jun 1 '10

    Quote from rrprn
    Recently our unit has had an increased number of women coming in with NO prenatal care. As scary as this has been, we recently had a stillbirth baby born to one of these women. This was not the woman's first birth without any prenatal care. There was very thick meconium fluid, but we had a fhr in the 150s up until the infant was delivered. As a newer nurse to OB I'm trying to figure out how to cope with the feelings of anger with the mother for not getting prenatal care when its available free and the sadness that I feel for her at the same time. I keep replaying everything in my head, trying to make sense of it all. Any advice would be greatly appreciated.
    Try not to look at it from the prenatal care standpoint. I don't know the history here but it's unlikely that prenatal care would have affected the outcome of having a stillbirth at term with mec. Many stillbirths are unexplained and it stands to reason that the vast majority of them occur in women with prenatal care.

    Research has shown that prenatal care does not improve outcomes in low risk women. In high risk women it improves outcomes only under ideal conditions (i.e. Centering Pregnancy model of care, mom has access to other social services and a good home environment, etc). So although we spend tons of money on prenatal testing and prenatal care, our outcomes have not improved as a result.

    As far as free prenatal care, imagine going to the DMV. Now imagine having to do that to get your medical card. Then having to be treated poorly at a health department or doctor's office because you are using that medical card. Having to find someone to watch your other kids and someone to give you a ride to the doctor. Maybe you work and you have to take unpaid time off to go to your appointments. Maybe you can't take time off or you will get fired. Probably getting referrred to social workers and asked all kinds of questions. It's easy to see why someone would opt out. Maybe you have an addiction that you can't get help for and you are afraid to get tested. Maybe you have an abusive partner who won't allow you to get prenatal care for fear you will disclose the abuse. Maybe you have a history of sexual assault and having an exam brings back those memories. Maybe your partner works and takes the car and you don't have a ride. Maybe you are in this country illegally and too scared to get help for fear of being deported. Maybe you don't speak English. Maybe you were raped or afraid to tell people about your pregnancy...

    I'm not saying it's the choice I would make. It's just that for some women navigating the system and finding a ride to an appointment and childcare for their older kids is sometimes just too much on top of everything else. And if they know that last time they couldn't get to the doctor and everything turned out okay they are not as worried. Also- prenatal care in the US lacks a lot when compared with other countries- maybe they had been disappointed by it previously and didn't want to go back.


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