Elective Primary C/S - page 5

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   Gompers
    Quote from 33-weeker
    I doubt your baby will weigh 10 lbs. Besides, I delivered my first baby, a 9Lb. daughter, without even needing so much as a stitch. It can be done. (The largest uncomplicated vag. baby I've taken care of was 12 pounds.)
    If I go full-term, it very well might be that big! The baby was about 5 lb, 12 oz at 33-1/2 weeks per ultrasound. Somewhere around the 60th percentile, but it has been as large as 80th percentile in the past. Definitely cooking a big one in here! I'm very very very short though (under 5 feet) so I'm hoping that I'll just run out of room and go into labor before it gets much larger than 8 pounds. I'm already having a lot of pressure down there and started waddling this week. Baby didn't drop yet, as I still have shortness of breath and worsening reflux. It's just that I don't have much room, period!

    If the baby is really really large, though, and not progressing very far down the canal during labor...I would definitely agree to a section. Reason being that in the NICU I've seen way too many asphyxiated babies who got stuck. A rare occurance, yes, but one that haunts you forever once you see it.
    Last edit by Gompers on Nov 25, '06
  2. by   judyblueeyes
    I don't care how any woman wants to deliver her baby- it's her right to choose and her wishes should be honored to the best of our ability.

    It seems that we maintain that we are the patients advocate... unless the pt chooses something that we don't agree with personally. That's not right.
  3. by   PANurseRN1
    Quote from RNLou
    So you think that an anesthesia provider refusing to provide you with unsafe care is asking for a lawsuit? Umm, no.

    It is standard of care that GETA is reserved for C-sec emergencies or those cases in which subarachnoid block or epidural would be contraindicated or has failed. Do you seriously think an anesthesia provider should be forced to provide you with whatever type of anesthetic you want, regardless of the risks? And you do have a choice. You always have a choice. It just might not be the choice you want. You can choose to have a neuraxial technique, or you can choose to have local anesthesia only for this major abdominal procedure, or you can choose not to have this ELECTIVE case done, at least not with the prudent anesthesia provider who is unwilling to risk your life by providing you with substandard care.

    I just find it odd that you think a provider has a duty to provide you with whatever kind of care you demand, regardless of practice standards or risks involved. A provider does not have a duty to provide you with whatever you want just because you want it. They may not be able to force you to do anything against your will, however, they can refuse to provide unsafe care to you.
    Yep. It's not Burger King--you don't get to have it your way.
  4. by   PANurseRN1
    Quote from judyblueeyes
    I don't care how any woman wants to deliver her baby- it's her right to choose and her wishes should be honored to the best of our ability.

    It seems that we maintain that we are the patients advocate... unless the pt chooses something that we don't agree with personally. That's not right.
    It's precisely that advocacy that dictates that we speak up when a pt. is demanding something that is unsafe and not in his/her best interests. It's not about the personal preference of the provider.
  5. by   CEG
    Quote from Gompers
    If I go full-term, it very well might be that big! The baby was about 5 lb, 12 oz at 33-1/2 weeks per ultrasound. Somewhere around the 60th percentile, but it has been as large as 80th percentile in the past. Definitely cooking a big one in here! I'm very very very short though (under 5 feet) so I'm hoping that I'll just run out of room and go into labor before it gets much larger than 8 pounds. I'm already having a lot of pressure down there and started waddling this week. Baby didn't drop yet, as I still have shortness of breath and worsening reflux. It's just that I don't have much room, period!

    If the baby is really really large, though, and not progressing very far down the canal during labor...I would definitely agree to a section. Reason being that in the NICU I've seen way too many asphyxiated babies who got stuck. A rare occurance, yes, but one that haunts you forever once you see it.
    Please don't have more faith in ultrasound than you have in your own body! It's true that you may be having a big baby, but your body is building that baby and chances are everything will be okay. Those rare ocurrances are just that- rare.

    I have always been a small person and delivered my 8'11'' first baby with no problems, a quick 30 min pushing. I have also seen in my short nursing school career several ladies who had sections for their "huge" by ultrasound 7 pound babies.

    Good luck- sounds like between your doctor and your ultrasound tech you have a lot of stress coming your way.
  6. by   2curlygirls
    I'm very very very short though (under 5 feet) so I'm hoping that I'll just run out of room and go into labor before it gets much larger than 8 pounds.

    Hee hee. You sound JUST like me. I am 5 feet on a good day and about 100 lbs (not pg) My DD #1 had a growth spurt at 39 weeks gestation causing lots of lovely stretch marks (if she'd only come early.....)I went 3 days post "EDD" and my water broke. I too pushed for 30 min, after a nice moderately long labor, and out came my giant 8lb1oz baby@@. (her head was indeed huge though and I did some mighty fine tearing despite the support during crowning and slow stretching). My point is, babies don't run out of room, they just go OUT further!
    What is it about short NICU nurses? We dominate our unit.
  7. by   Gompers
    Quote from 2curlygirls
    My point is, babies don't run out of room, they just go OUT further!
    You're telling me. I'm 34-35 weeks but I look full-term, easily. By 32 weeks my belly had outgrown half of my maternity clothes. :uhoh21:
  8. by   passgasser
    tntrn

    First of all, rational or not, your fears are real to you. As an anesthesia provider, I recognize that fact, and have dealt with this very situation several times. I would not dismiss your fears, neither would I ignore them. You have the right to an anesthesia provider who would, at the very least, sit and discuss your fears with you to try to relieve you of some of the stress you are experiencing.

    Though you would never elect to have a c-section, both of us know that there are times where a c-section, though neither emergent or urgent, is medically indicated. For example, if a woman has had a prior c-section, and is presented with all the facts regarding VBAC vs repeat c-section, it is perfectly valid for her, and medically sound for her OB doc, to decide not to take the risks associated with VBAC. I actually took care of such a woman, who because of the emergent nature of the situation with her first child, had to be put to sleep for that section. She presented for a repeat section, and she had many of the same fears you have regarding neuraxial anesthesia. In my interview with her, after taking her history, I told her we would be doing a spinal technique for her second section. She let her fears be known, and I had a long talk with her about the various kinds of anesthesia, and why general anesthesia for c-sections was reserved for only truly emergent cases. (This discussion lasted a good 30 minutes.) I answered all of her questions, and by the time we were done, she elected to have the section, with the spinal I recommended.

    The point of this little story is to let you know that I never dismiss a patient's fears out of hand, but I also never allow a patient to steer a clearly dangerous course, when safer options are available. That's why I went to school for such a long period of time. I would far rather deal with a patient's psych issues, both in the pre-operative interview, and during the section, than to deal with a woman who has aspirated, or worse got into a can't ventilate, can't intubate situation because I allowed her to dictate anesthetic technique over my better judgement.
  9. by   SmilingBluEyes
    Our anesthesia providers are EXCELLENT at discussing all aspects/types of anesthesia with their patients, benefits/risks and expectations/limitations of each-----and I have seen them allay the fears of many a panic-sticken lady. I have faith in their ability to decide, along with the patient and her s/o, which course is the best way to go and why-----and I have seen the results. They are an amazing group, IMO.

    Just had gallbladder out myself 2 weeks ago. I have been "asleep" several times for various surgeries. HORRIBLE experiences, all of them, emerging from the general. Just horrible. BUT---Have to say, this was my best experience ever. Simply because the MDA listened to my concerns over prior extreme nausea/vomiting and hangover after anesthesia. This time, when I emerged, it was like waking from a deep sleep, nothing more.

    I am glad there are providers like gasspasser and Lou to take care of our parturients in their most vulnerable and special moments. You guys make the difference in many cases, between a great experience and out and out ordeal. Carry on!
  10. by   tntrn
    Quote from passgasser
    tntrn

    First of all, rational or not, your fears are real to you. As an anesthesia provider, I recognize that fact, and have dealt with this very situation several times. I would not dismiss your fears, neither would I ignore them. You have the right to an anesthesia provider who would, at the very least, sit and discuss your fears with you to try to relieve you of some of the stress you are experiencing.

    Though you would never elect to have a c-section, both of us know that there are times where a c-section, though neither emergent or urgent, is medically indicated. For example, if a woman has had a prior c-section, and is presented with all the facts regarding VBAC vs repeat c-section, it is perfectly valid for her, and medically sound for her OB doc, to decide not to take the risks associated with VBAC. I actually took care of such a woman, who because of the emergent nature of the situation with her first child, had to be put to sleep for that section. She presented for a repeat section, and she had many of the same fears you have regarding neuraxial anesthesia. In my interview with her, after taking her history, I told her we would be doing a spinal technique for her second section. She let her fears be known, and I had a long talk with her about the various kinds of anesthesia, and why general anesthesia for c-sections was reserved for only truly emergent cases. (This discussion lasted a good 30 minutes.) I answered all of her questions, and by the time we were done, she elected to have the section, with the spinal I recommended.

    The point of this little story is to let you know that I never dismiss a patient's fears out of hand, but I also never allow a patient to steer a clearly dangerous course, when safer options are available. That's why I went to school for such a long period of time. I would far rather deal with a patient's psych issues, both in the pre-operative interview, and during the section, than to deal with a woman who has aspirated, or worse got into a can't ventilate, can't intubate situation because I allowed her to dictate anesthetic technique over my better judgement.
    Thank you for your thoughtful response. I'll bet your patients, and staff, really appreciate you too. That being said, in 30 years of nursing, I have NEVER seen an anesthesia provider spend 30 minutes with a patient, except for during the procedure or surgery.

    Our guys do "talk" to the patients, but it's to mumble a little mantra that they've mumbled a million times before and they say it so fast, I doubt if anybody can really know what was said. I honestly don't think it's fair to the patient, especially when it's done during labor and the attention span is already compromised.

    Often, one of them will come through, ask if anybody is wanting an epidural, and if we say, "well, Mrs. SO and SO, is interested, but not yet, or she's not sure, they'll get all huffy and say, well, she'd better get it now or never. And then there are a couple of them who think that it IS their job to convince a labor patient that they should get one. All of this, perhaps, along with those who take 30 minutes just to get one placed, with multiple sticks that leave backs looking like hamburger, might be part of my own personal fear.

    Admittedly, it's not a completely rational fear. I won't watch them place one. Luckily, I am on the other side, helping my patient with positioning, holding still and all of that.

    Also, I'm almost 58 so I'm never going to have to deal with it. Equally lucky, for my own surgeries, I've never had any N & V afterward so that's definitely a plus. There's always a payback though---I can only take Darvocet for pain as I'm allergic to all the heavy hitters, so I've managed through two orthopedic surgeries and a breast reduction with that and Motrin.

    If nothing else, maybe my own fears and my telling of them, will bring it to the attention of other nurses and "gas passers:spin:" that although the accepted and recommended procedure, it is not without repercussions. Please, to all of you, do not overlook or dismiss patient fears or concerns as "having the willies" It just might be so much more than that. Thanks.
  11. by   33-weeker
    Quote from RNLou
    I just find it odd that you think a provider has a duty to provide you with whatever kind of care you demand, regardless of practice standards or risks involved. A provider does not have a duty to provide you with whatever you want just because you want it. They may not be able to force you to do anything against your will, however, they can refuse to provide unsafe care to you.
    Amen! :yeahthat:
  12. by   mitchsmom
    i don't know if anyone already brought this recent study up, but here's a synopsis:
    infant deaths after c-sections rise even in low-risk pregnancies

    ..."researchers at the u.s. centers for disease control and prevention analyzed data from more than 5.7 million live births and nearly 12,000 infant deaths over a four-year period."

    ..."the study found that the death rate among neonatal infants delivered by caesarean section was more than twice that of infants delivered vaginally. this held true even after the researchers adjusted for socio-demographic and medical risk factors."

    here's the abstract: infant and neonatal mortality for primary cesarean and vaginal births to women with "no indicated risk," united states, 1998–2001 birth cohorts
  13. by   SmilingBluEyes
    I have read that before, and it does concern me greatly, mitchsmom. Like I said before, push Mother Nature too hard, and she will give a hearty and ugly shove back.

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