Elective Primary C/S - page 2

On our unit, Primary Elective C/S have become pretty popular, for this main reason, "I don't want to go through the pain of labor". Now, with that said some of these young ladies insist on also... Read More

  1. by   LizzyL&DRN
    Quote from mitchsmom
    Yes, they are.
    Why has it become acceptable? That's the question... my quess would be that it demonstrates the power of the MD's &/or fear of litigation. We'll see if the power of insurance companies comes into play at all when they get sick of paying for more and more c/s. ??? There is also obviously a lot of misinformation or partial information getting out on vag vs. cesarean birth; some people do not realize that risks are much higher with c/s.
    I always thought the reason they started allowing these types of sections was because they made "pain" the 5th vital sign. Pts can sue doctors and hospitals because they were in too much pain during their hospital stay, and this applies to OB pts as well. I've heard stories of lawsuits because of pain in the OB setting, including laboring pts. I think its ridiculous, but in todays sue-happy world, pts can say they want the section because they don't want the pain of childbirth. I just don't understand why they think the pain is less w/ a section.........We all know its not.
  2. by   santhony44
    Quote from LDRNMOMMY
    :yeahthat:


    I don't mean this disrepectfully but...You think general is going to take your pain away??? Think again, the second you wake up you will be hurting like you have never hurt in your life. (at least that is what my patients tell me) and it takes a LONG time to get it under control. It has been my experience (albeit breif) that my patients, for the most part receive adequate pain control with the preservative free morphine in the spinal/epidural, plus the remainder that is given IV.

    Having had two sections with epidurals, and an open abdominal surgery with general, I'd take the epidural any day of the week.

    When I had my second, scheduled section, the anesthesiologist was in the process of putting my epidural in when people started running around like mad. I got repeated apologies because my section was delayed when my doc had to do an emergency section on another mom. (Fetal heart rate dropped, couldn't get it back up, it turned out to be an abruption). Anyway, this other mom was in the room across the hall from me postpartum. She'd had the emergency section under general, I'd had the scheduled one with an epidural. I firmly believe she was in way more pain than I was.

    Duramorph is a wonderful, wonderful thing.

    And, for the record, I was not upset at being bumped back. I kept telling them to take care of that baby, mine was fine.
  3. by   subee
    [QUOTE=tntrn;1934478]Ah, another reason why I'll be happy to retire in a couple of years. Perhaps we should just install zippers at the first prenatal visit and get it over with. If the patient has said she doesn't want the pain of labor then that, unfortunately, is being used as a reason. Quicker, easier (for the doc anyway) and more $$ in the till. I'm so uneasy about the trend also.

    It sounds like there are two issues here: one is patients requesting and getting an elective primary c/s and the other is being scheduled for one, but requesting a trial of labor. Questionnable practices in both cases, IMHO.

    I have to agree with the spinal/epidural thing. There's NO WAY IN, well, no way, I'd ever agree to having either. It just freaks me out and in 30 years of labor nursing I have seen few, very few indeed, c/sections which were done so slowly as to compromise the infant. They are fast, no matter what, so why not let the patient truly decide, instead of pressure them into having that needle stuck in their back. In more cases than I can count, the spinal or epidural wasn't adequate, the patient had pain issues during the surgery, only to be told it was "pressure." Yeah, right. Not me, baby. Put me to sleep, play your music, do your job and I'll b e oh-so-happy when I wake to have it all done with.[/Q


    Putting a patient to sleep for a c-section without a compelling reason (i.e. bleeding issues, serious fetal distress) is shoddy practice - period. So is giving them elective c-section. Has the caliber of physician who chooses this type of practice gotten that low? We had a young patient recently who came in and requested an epidural immediately so I guess the midwife figured that they might as well start a pit drip. Fortunately, the patient's mother showed up and she was a midwife and said no go to either and gave the midwife a tongue lashing for even considering a pit drip on someone who just walked in the door. Daughter delivered without either. A happy and ethical ending for all.
  4. by   tntrn
    Thank you for the information regarding epidurals and generals...I've been a labor nurse for 30 years and already know all of that. My own personal bias against epidurals is NEVER communicated to patients. If they ask me if I would have one, I say something about it being a personal choice and every situation is different.

    I WOULD NOT agree to have one. Period. For any reason. The idea of that needle going into my back is one of the few things that can put me over the edge. One of my sisters is a CRNA so when I have questions I've never had far to go.

    And some anesthesia providers DO pressure patients to get an epidural. As do docs. Not all, but some.

    I didn't take your comments as flames, but I guess you took mine as uninformed comments, rather than personal views. Sorry for that.
  5. by   BSNtobe2009
    Britney not only had an elective c-section, with both children she went in 6 weeks before her due date to avoid stretch marks...why is the American Medical Association not pulling licenses for this sort of thing?
  6. by   Jolie
    [QUOTE=BSNtobe2009;1938223why is the American Medical Association not pulling licenses for this sort of thing?[/QUOTE]



    Because they don't issue licenses, or have any authority to discipline them.
  7. by   Marie_LPN, RN
    Quote from mitchsmom
    Yes, they are.
    Why has it become acceptable? That's the question... my quess would be that it demonstrates the power of the MD's &/or fear of litigation. We'll see if the power of insurance companies comes into play at all when they get sick of paying for more and more c/s. ??? There is also obviously a lot of misinformation or partial information getting out on vag vs. cesarean birth; some people do not realize that risks are much higher with c/s.
    One OB that used to be at our hospital would OK to do a section just so he's not "sitting around forever waiting for her to push."
  8. by   Ado Annie
    Wow, I'm just amazed that there are doctors agreeing to this.

    And if the reason is to "avoid the pain of labor", well, I've got news for those girls. Granted, I never experienced labor, but the section was not a walk in the park.
  9. by   bethin
    Quote from BSNtobe2009
    I think it's a very tough call. I think scheduled c-sections for vanity reasons (like 6 weeks early so someone won't have stretch marks) they should be illegal. There is a reason why nature has set human gestation at 9 months. I feel the same about induced labor when there is no medical reason, so someone can have the baby on a Friday, or some other silliness.
    You've got to be kidding me. Why not take the soon to be mom for a stroll down to the NICU and see what pre-term babies look like and the problems that can arise from an early delivery? A dr. performing a c-section early for a reason such as vanity issues should be sued for endangering a child.

    Hey, when you're pushing a watermelon through a hole the size of a straw it's gonna hurt.

    I actually did a research paper on the increase in c-sections in the last ten years. Got a 99% on it. I'll see if I still have it saved because it has some very good statistics on c-sections and complications.
  10. by   SmilingBluEyes
    Read an article stating nationwide c/section rate was 30% in 2005. This is a scary trend to me.
  11. by   BSNtobe2009
    Quote from bethin
    You've got to be kidding me. Why not take the soon to be mom for a stroll down to the NICU and see what pre-term babies look like and the problems that can arise from an early delivery? A dr. performing a c-section early for a reason such as vanity issues should be sued for endangering a child.

    Hey, when you're pushing a watermelon through a hole the size of a straw it's gonna hurt.

    I actually did a research paper on the increase in c-sections in the last ten years. Got a 99% on it. I'll see if I still have it saved because it has some very good statistics on c-sections and complications.
    Amen sister!
  12. by   BSNtobe2009
    Quote from SmilingBluEyes
    Read an article stating nationwide c/section rate was 30% in 2005. This is a scary trend to me.
    I'm not concerned with the increase in c-sections, because I believe the majority of OB-GYN's are c-sectioning patients more quickly when they are running into valid medical issues with either the mother or the baby and at the same time, infant mortality rate is going down, and this is most-certainly contributing to it.

    As a mother, no amount of pain or surgery is too great in order to ensure that I give birth to the healthiest baby I possibly can. It makes me physically ill to hear about cases where a baby was fine and then something goes wrong with the birth that leaves the baby permanently damaged for life.

    I'm just against convenience c-sections and feel they are medically unethical.

    PS: Another thought...wouldn't convenience c-sections also be insurance fraud? I guarantee the insurance companies are getting told they are medically necessary, otherwise, why would they pay for them?
  13. by   SmilingBluEyes
    Well, the increase in c/section rates should concern us.

    As an OB nurse, I am privvy to some pretty rotten situations you may not have seen as a person not in nursing just yet---- I have seen cases whereby csections were performed hastily and unduly---due to things as petty as physician impatience and/or unnecessary intervention. I have seen a rise in non-medical necessity inductions for labor, which guess what, raises the chance a woman will have a csection hugely. Surgery carries inherent risk that vaginal delivery (in low risk situations) does not.

    I have also learned in my years in nursing that interventions tend to pile up and create problems, leading to increased chances of ----you guessed it---csection. I have seen situations that made csections necessary due to inappropriate intervention/haste, NOT legitimate medical need, as you refer to. In other words, the medical need arose due to our intervention, not as a result of a pregnancy complication that was discovered that needed intervention in the first place.

    I am concerned that the rate of csections is predicted to reach 50% in the next 5 to 10 years. I should think we all should be. This isn't right.

    PS: our infant mortality rates in the USA are dismal, when compared to other industrialized nations, where csection rates are less than half ours---and the majority of healthy women give birth at home or in midwife-run birthing centers. So I do not believe the rise in csection rates is doing our moms or babies any huge favors; I can't be convinced when I read the grim statistics.
    Last edit by SmilingBluEyes on Nov 24, '06

close