C-sections for premies

webbiedebbie · Mar 29, 2003

Oh, by the way, mom and baby are doing fine.

Jolie, BSN · Mar 30, 2003

This is not a new practice, maybe just a rare instance of it being put to use. A study was published about 8 or 9 years ago clearly defining the benefits of decreased trauma and fewer intracranial bleeds in preemies delivered by C-section. Unfortunately, not many OB's do elective C-sections for preemies, although I'm not sure why. Perhaps they are not aware of the study, or do not believe in subjecting mom to the added risk of an operative delivery in cases where the baby's ultimate survival is questionable. I'd be interested in hearing what other nurses see in their practices.

Vsummer1 · Mar 30, 2003

Just a student's understanding of this: If the infant needs to be removed from the intrauterine environment than the c-section would be warranted. You would have to soften up the cervix, then dose with oxytocin to start the birth process. This could take time along with possibly having hyperstimulation of the uterine contractions and bring stress to the baby. It is the age of the fetus / baby and why it needs to be removed at that early of a date. Any stress of navigating the birth canal and enduring contractions would be eliminated with a c-section, affording the baby a (possibly) better outcome.

Does this sound right?

mark_LD_RN · Mar 30, 2003

the main reason it is done is decreased birth trauma premies are real susceptable to intercrainial bleeds. I have also seen docs use forceps to protect the head of a premie during a lady partsl birth.

**canoehead, BSN, RN** · Mar 30, 2003

Forceps to PROTECT the head? Sounds like an oxymoron to me, but perhaps the docs I work with are not as skilled with the forceps.

HazeK · Mar 30, 2003

Originally posted by canoehead
Forceps to PROTECT the head? Sounds like an oxymoron to me, but perhaps the docs I work with are not as skilled with the forceps.

Yep, to actually protect the baby!

I wish I could remember the "pounds per sq inch" of pressure that typical lady partsl vault excerts on a fetal head, but it was a jaw-dropping number! A physician WHO IS SKILLED in forceps' use, can indeed protect the fetal head from the surrounding tissues. The forceps are not used hardly at all for traction, leaving the mother to still push out the baby, as much as to guide the fetal head under the symphisis and out..

Less IC bleeds!

Hugs

Haze :cool:

NicuGal, MSN, RN · Apr 2, 2003

Actually, they have determined that if the baby is in good position, not breech or sidelying, then lady partsl is the way to go. Even the kids with open gut problems are delivered lady partslly if able. Do the vag vs c/s kids do better....a preemie is a preemie..if the lungs are good to go, so is the baby. Why give them the anesthesia if they don't need it. Also, we haven't seen an increase in IVH's with lady partsl births. And I have NEVER seen an OB use forceps or vacuum on a preemie....right there is asking for trouble. Most IVH's aren't caused by birth trauma but by fluctuating BP's and physiological changes in the baby.

mark_LD_RN · Apr 3, 2003

well said hazeK-- they use the forceps just to protect the head no traction at all is applied.but it takes skill. vaccum is never used on premies !as matter of fact our protocol says 34 weeks or less do not use vaccum:)

mother/babyRN, RN · Apr 6, 2003

If it is an emergent thing, thats also the quickest way to do it...More details?

dawngloves, BSN, RN · Apr 6, 2003

Only do preemie c/s on eclamptic moms, poor fetal tracings, certain anomolies. I haven't really noticed a correlation between SVD and IVH or even hyperbili for that matter. I'd think the rational is that every minute in utero helps or it's a better transition?