C-section vs. letting Mom go naturally - page 3

Why am I hearing more and more of Dr.'s that ASK their patient's if they want to have a c-section instead of waiting and letting nature take it's course and baby comes naturally? I just don't get it!... Read More

  1. Visit  NicuGal profile page
    4
    Ugh...and those are the kids we get in our NICU....the ones that the docs do the c/s on weeks before the due date without good cause! Luckily, the vast majority of our OB's don't do this and they are slowly weeding out the ones that do.

    People like it because they get to pick their due date, etc. Just had one from another hospital that was like your friend, except the kid turned out to be under 7 pounds, 36 weeks and had severe RDS, ended up on the vent, nitric, pressors, etc. The mom was like, well they never told me this could happen...no darling, they never do.

    I believe if they are going to do c/s earlier than the due date, they better be checking lung maturity....several of our docs do and that at least gives us a heads up!
    kacefaceRN, GooeyRN, JRP1120, RN, and 1 other like this.
  2. Visit  sgo13 profile page
    1
    I totally agree with the person that recommended "The Business of Being Born". I watched it on Netflix also. It was very interesting.
    JRP1120, RN likes this.
  3. Visit  nohika profile page
    1
    Quote from JRP1120, RN
    Fear of litigation over what? A healthy mom more than likely vaginally delivering a normal, healthy baby?
    Unfortunately, it's the "less than likely" complications that make the docs paranoid. You can never 100% guarantee a risk-free delivery. It's all the commercials out there that are "Did your OB doc do XYZ while you were pregnant/was your baby born with XYZ? You may have a case to sue! Please call, blahblah". It's hard for them to assume when that one assumption could accidentally land them in court...being sued.
    Not_A_Hat_Person likes this.
  4. Visit  Elvish profile page
    3
    When my cousin was pregnant with her 2nd, she called me very upset. Her doctor had done an ultrasound and recommended a c/section for her because they suspected macrosomia. This makes me really mad when docs do this. She was not gestational diabetic, her pressures were fine. There was nothing else wrong with her pregnancy other than they 'suspected' a large baby. I told her that I couldn't make the decision for her, but to remember 1) that women's bodies do know how to birth babies, and 2) 3rd trimester ultrasounds are notorious for being inaccurate. Her first had been over 8lbs and she had no trouble birthing him at all, and I asked her to remember that too. (Women in our family tend to grow them big - if it weighs anything under 9lbs, they ask you if that's the best you could do. My uncle was almost 12lb, NSVD, minor perineal tearing.)

    Well, the ultrasound was right - he was a large baby. 9lb 15oz, to be exact. Birthed vaginally. The same doctor who suggested the section also caught this baby, which I think served her right.

    IMO, it is a mix of things: control issue, fear of litigation, fear of losing revenue if you don't give the patient what she wants, being sick of a particular patient calling the office, and sometimes it is honest-to-goodness (if misplaced) a feeling of having the patient's best interest at heart. I think all those things come together to increase the elective c/s rate. It's probably not every one of these things for every doctor, but I think this covers most of the bases for most doctors. Most OBs I know are decent people and aren't out to intentionally harm anyone, but they only know what they've seen. It's amazing to think that there are doctors out there who've never been party to a low- or no-intervention birth.

    After recovering people from both NSVDs and from sections, give me ten NSVDs any day of the week before slicing my belly open once.
  5. Visit  KareBear0609 profile page
    3
    How about just the simple fact of being induced? It drives me nuts when women are induced just because they are going on a vacation or their husband can only take off work such and such week. Or they are told their baby is going to be 9+ lbs, they deliver 3 weeks early, and it comes out 7lbs.
    GooeyRN, JRP1120, RN, and caregiver1977 like this.
  6. Visit  caregiver1977 profile page
    2
    My OB offered a c-section with my second (my first was induced for pre enclampsia, so was my second in the end). He actually looked shocked when I told him no. SMH.
    GooeyRN and JRP1120, RN like this.
  7. Visit  shart profile page
    1
    It is why I won't go near l&d when I finish my nursing program. I'm tired of doctors practicing "cover their ass" medicine. They pressure or encourage intervention births so they can have control over the situation. They don't care what's best for moms or babies, but what's best for them. Malpratice insurance doesn't help either when they refuse to cover doctors who deliver VBACs and such. Hospitals aren't helping as they ban VBAC instead of encourage VBAC. The US system is all messed up.

    When I was pregnant with my twins I had to search for a doctor who was willing to even try a vaginal birth. The real kicker is I had a proven pelvis! I had another son prior to them and with zero complications. Yet I was basically told "C-section!" for no reason. I finally found a high risk OB who would be okay with a natural delivery. I still have:heartbeat for that man. Not only did he not even suggest an epidural when I came into l&d in labor, but he stayed with me in my room through-out most of my labor. He only left once for a small coffee break. I delivered two healthy babies who were both almost 6lbs. No complications. No epidural. No NICU. I have no doubt if it had been any other doctor I'd have had a c-section. I'm not having anymore kids and I'm glad because I'm getting more and more scared of the system. In the US right now our c-section rate is really high and only keeps going up. Studies have proven that it's not because of more complicated deliveries. A good portion of them are SIMPLY repeat c-sections. Why we don't encourage VBAC and get more hospitals doing them I'll never know especially since more and more studies are showing that VBACs are safe. The risk of rupture is only a fraction of a percentage higher than a first time mom.
    Last edit by shart on Jun 30, '11
    JRP1120, RN likes this.
  8. Visit  klone profile page
    7
    For those of you who are horrified at the idea of working in OB and all the interventionist medicine that takes place, let me assure you that not all places are like that.

    I currently work at a teaching hospital that has the lowest C/S rate in Colorado. The residents are taught EVIDENCE BASED MEDICINE, not "CYA Medicine". I took care of a patient that had a crappy strip all night. Decels into the 60s with every single contraction. For several hours. I had reached my personal threshold by around 1am and wanted to take her back for a section at that time (and I'm very crunchy granola natural birthing, dislike interventions kind of person). The midwife felt the same way. It was the chief resident who talked US down, pointed out that the baby had good variability between decels and was clearly not acidotic, and it was okay to sit on the strip a little longer. We ended up sitting on the strip until 6am, when the woman delivered vaginally with a perfectly healthy baby. If it had been up to the midwife and me, she would have been sectioned at 1am. But because of the cool head of the resident, this woman got the vaginal birth she wanted.

    Our facility allows waterbirths, it allows mothers to not have an IV if she so chooses (assuming she's not being induced), it does not offer "social inductions" and inductions for post-dates don't occur until after 41 weeks (I've taken care of some almost 43-weekers). We do VBACs as well as vaginal breech deliveries.

    So even though the "CYA" method of practicing medicine is prevalent, it's definitely not everywhere. If you have a desire to go into OB nursing, don't let the horror stories scare you away. It may be harder to find, but true evidence based practice of medicine does exist, even in OB.
  9. Visit  JRP1120, RN profile page
    0
    Quote from sgo13
    I totally agree with the person that recommended "The Business of Being Born". I watched it on Netflix also. It was very interesting.
    I'll be watching it tonight!
  10. Visit  nursetiffany. profile page
    2
    scary. as a nurse and pregnant with number two...i go as natural as possible. our bodies r made to handle birth...why not let them unless medically necessary? hell, i think taking pain meds during labor is dumb. bit too each their own.
    GooeyRN and JRP1120, RN like this.
  11. Visit  JRP1120, RN profile page
    0
    Quote from KareBear0609
    How about just the simple fact of being induced? It drives me nuts when women are induced just because they are going on a vacation or their husband can only take off work such and such week. Or they are told their baby is going to be 9+ lbs, they deliver 3 weeks early, and it comes out 7lbs.
    This same thing drives me nuts too! All of theses factors are what makes me want to stay away but stinks too because I'm pulled in that same direction and would LOVE to be a part of it all. I want to be a part of helping to bring babies into the world (my second love behind NICU). But I think I would rather be the educator and the one to reinforce her choice to go vaginally (and naturally) and cheering her on during labor, helping her to have the birth experience she wants (doula anyone? Lol). The elective c-sections, inductions for no reason and the pushing of epidurals and drugs that seems to go on more and more these days, "just because", are what I think would frustrate me to no end. In our facility, from the little I saw in my OB rotation, I would prob be frustrated (and we are a teaching hospital with tons of residents). Ugh.
  12. Visit  JRP1120, RN profile page
    1
    Quote from tiffe88
    scary. as a nurse and pregnant with number two...i go as natural as possible. our bodies r made to handle birth...why not let them unless medically necessary? hell, i think taking pain meds during labor is dumb. bit too each their own.
    I remember lonnnng ago when I had my first, I was in labor for over 34 hours...I had an older Dr that knew I wanted to go natural. I'm a very petite woman, short and only going over 100 lbs when pregnant (well, not anymore! Haha). I labored and labored to the point I was so exhausted I fell asleep in between contractions (my mother watched the monitor and as a contraction started I'd wake up and start my breathing and as soon as it was over, out I would go again! Pretty cool how our bodies compensate!). While I was pushing to get my baby to crown (for hours! Ugh), the nurse got concerned because my baby's HR dipped too low a few times too many. She went and told the Dr and he had me push with every other contraction. All was fine. That did the trick. Not once did I hear the word "epidural" or "c-section". Granted, had my baby's heart rate continued to drop or not be fixed by turning me and only pushing with e/o contraction, I'm sure it would have been a c-section for me. I did have a shot of Demerol at some point, which probably contributed to the sleeping btw contractions but my doc was of the philosophy that my body was made to do this and as long as there weren't any adverse things happening, he was going to let me go that way...so glad he did. I'm glad I listened to my mother too. All throughout my pregnancy (and labor), she would tell me how women have been doing this since Adam and Eve times and that we were NOT going to die (although I felt like it during all that labor!). I carried that with me for my next two pregnancies and births and nope, I didn't die and yes, all my babies were born vaginally and the correct weight that my body could handle. All my kids were just over 6 lbs and my body held them in until the middle of my 38th week. I fully believe that my friend's body can handle this baby if he/she is 9 lbs or more and that her body would spit it out when it was done and ready. Errrrr!
    caregiver1977 likes this.
  13. Visit  OBRN2011 profile page
    3
    You are preaching to the choir! We watched a documentary in nursing school regarding the outrageous numbers of scheduled c-sections in the U.S. as opposed to other industrialized nations. Over in Europe, they embrace natural childbirth, home births, and midwives. One thing we tend to forget is that birth is a normal process and a majority of mothers are healthy, not sick so why do major surgery?
    I agree that OB nursing is not for everyone. When it's good, it's great. When it's bad, it's the worst day of your life. It is frustrating to deal with physicians who practice based on convenience whether it be their own or the parents. However, there are some wonderful OBs out there and CNMs are becoming more and more popular. I love OB, I love taking care of mom and baby, witnessing miracles every day. Having a baby is a momentous occasion in people's lives and getting to be part of that is an amazing feeling. I love watching new parents together with their newborn, witnessing private moments between new families. That makes up for the bad. Despite it all, these are not the reasons I wanted to be an L&D nurse. When I took my OB rotation, I saw that many of these women were not very well informed as to their options. I think that if women were better informed, many would stand up for themselves and opt for a more natural way. This is the reason I wanted to be an L&D nurse. I want to educate my patients, to help them achieve what they want, to support and advocate. Afterall, isn't that what nursing is really about?

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