C-section vs. letting Mom go naturally

Specialties Ob/Gyn

Published

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!

I have a friend that is pregnant for the first time, isn't due for a few more weeks, has a very healthy pregnancy, no problems with her or the baby except that at last U/S, they guesstimated the baby is almost 9 lbs and has still not descended any and her cervix is still closed and thick. He offered her a c-section in a few days and she took the offer! Ugh! Ok, I may be old-school here in my thinking but I just don't see why any Dr. would offer that (besides they see it as easy money in their pocket) or why any woman would want that!! C-sections are major surgery to the body, as we all know. They are relatively easy in uncomplicated pregnancies but there is still more room for post-op infections, bleeding problems, etc...why can't Dr.'s just leave well-enough alone and let nature take it's course and let the woman's body do what it was made to do and has been doing for centuries...the baby will come out when it's good and ready, her body will tell her it's time to deliver that baby. She's not even at her due date yet, and it's her first baby, of course the baby hasn't descended yet and there's no dilation! Duh! Give it a few weeks, tell her to go walking, have sex, etc...geez!

I can totally understand if there were underlying circumstances here that would make a c-section the better option, but for my friend, there isn't any. It's not even a case where the Dr. doesn't think the baby will pass through the birth canal, he just gave her a choice, and being first-time pregnant and tired of being pregnant, she took the c-section. Baffles me!:uhoh3: I'm an advocate for natural birth, as natural as medically possible of course and I'm all for women making decisions and all but to me, this is just ridiculous that a Dr. would suggest this to a first-time mom who will never even know if her body can deliver a baby naturally, and more than likely, she never will be able to experience that (even though I realize there are VBACs though it seems more and more Dr.'s are going away from those as well).

What do you all see in your L&D's? Is this practice normal when there are NO medical reasons for a c-section? :confused:

Specializes in Anesthesia.
People should do that any way, before they turn down any medical intervention or before they ACCEPT one either. I am still glad that I turned down epidurals and the elective c-section. I wish I had of turned down all the pain meds I took during labor (I think I could have if I had more family/friend support during labor).

I never really understood taking IV/po pain medications over getting an epidural, but I respect each of my patients choices as long as it is safe and if it isn't safe then I just won't participate in their care. Pain medications (non-epidural) during labor have much more cognitive effect on the patient and effect the baby a lot more than the normal epidural ever will. Beside the fact that most IV/po medication never truly help with the labor pain anyways unless you give the patient such a big dose they practically stop breathing.

Specializes in Anesthesia.
I can respect where you're coming from, but the problem with telling people to either get stuff or stay home is that home birth in my state is even less safe because CPMs aren't legally allowed to practice, there are no OBs that do it, and there are exactly two nurse-midwives that do it. So if you want a home birth and you're unlucky enough to not live by one of the CNMs you are essentially forced to either go it alone, or deliver with a CPM whose practice in this state is unregulated and who may or may not have the skills to safely catch your baby. It's a pretty unfair conundrum.

About the risk of losing eyesight and cerebral bleed, the bigger concern is the eyesight. I'm really okay with people who decline the Vitamin K. It won't prevent early-onset HDN, and the incidence of late-onset HDN is extremely uncommon in untreated infants. Cerebral bleeds in term healthy newborns are very rare. Unfortunately, people can and do sue for much less than a brain bleed and currently there isn't much anyone can do to stop it.

All these things maybe rare, but that doesn't stop them from popping up or becoming less rare when people are encouraged by various sources to refuse them.

I just anesthesia for a tracheostomy for epiglottis presumably caused by HIB which should have never happened.

Specializes in Community, OB, Nursery.
All these things maybe rare, but that doesn't stop them from popping up or becoming less rare when people are encouraged by various sources to refuse them.

Some things - like HDN - are rare enough to begin with in untreated infants that I can't spend time getting worked up about parental refusal, unless parents also want the kid circed. I'm honestly more worried that someone will decline eyedrops and later pop up + for gonorrhea....but it's still parents' choice. Most patients I deal with who refuse have researched their options well.

It is difficult when we (including myself here) see everything that can go wrong. I'm not swiping your perspective.

I never really understood taking IV/po pain medications over getting an epidural, but I respect each of my patients choices as long as it is safe and if it isn't safe then I just won't participate in their care. Pain medications (non-epidural) during labor have much more cognitive effect on the patient and effect the baby a lot more than the normal epidural ever will. Beside the fact that most IV/po medication never truly help with the labor pain anyways unless you give the patient such a big dose they practically stop breathing.

I had Stadol and Demerol (had allergic reaction to Demerol the second time I had it, I almost stopped breathing) during some of my labors. When I didn't have an allergic reaction, these drugs helped me to calm down and sleep between contractions. I think it was just enough medicine to help. However, I think the two labors I had without any drugs at all were better for my babies. They seemed to breastfeed A LOT better and were the only two that did not develop jaundice.

I just didn't think I was in enough pain to have something like an epidural. By the time I was just overwhelmed by the pain and saying crazy things to the OB that had him looking at me wide-eyed the baby would be crowning. By then everything is almost over.

The crnas ,somewhat snarkily, call lady partsl births " failed c-sections".

Specializes in Anesthesia.
The crnas ,somewhat snarkily, call lady partsl births " failed c-sections".

Not all CRNAs.....and personally I think doing anesthesia for c-sections are a pain in the butt.

C-sections are PITAs. We are being sarcastic because the c-section rates keep climbing and climbing and we can't believe the ob-gyns let one slip by without sectioning it.

Specializes in OB.
C-sections are PITAs. We are being sarcastic because the c-section rates keep climbing and climbing and we can't believe the ob-gyns let one slip by without sectioning it.

Just curious as to why you consider c-sections to be PITAs. Not criticizing - just wondering as I have noticed multiple anesthesia providers who seem not to want to have anything to do with OB patients. Is there something that makes them more difficult for anesthesia?

That was erythromycin and it is a state law in many states for newborns to receive it, so that probably wasn't even an option. The erythromycin ointment decreases the chance of blindness in newborns from bacterial infections transmitted from the mother.

Vit K is one of the 1st shots that newborns get to prevent bleeding. http://newborns.stanford.edu/VitaminK.html

Hep B is the third thing that is done routinely to newborns - which can also be declined.

I know a number of families that will decline Vit K shots, but will give it orally (rutine in Europe) on the 1, 10, 30 day schedule as there is some data to suggest that newborns given the Vit K oral are less likely to get jaundice.

BTW - All things can be declined - helping your pts understand why we doing things routinely helps them in the long run. I have no issues with people declining all three in a normal non-traumatic birthing situation, but i want them to understand what they are declining and not to feel bullied. Yes, all states pretty much say that all newborns should have these three things along with childhood vaccines but they cannot actually require that each and every child has them - every state has an out, it is usually not well advertised tho

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