Elective Primary C/S - page 6

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   May_baby
    NIH State of the Science Conference:
    Cesarean Delivery on Maternal Request

    I attended this conference last spring as part of my work duties with the Federal Gov't and the whole conference was simply fascinating. The final statement and summary released by the panel is still controversial.

    If you are truly interested in the subject check out the archived conference footage and final report.
  2. by   mugwump
    Granted I haven't read every response. I had a C/section with my first. (decels) a repeat section with BTL with my 2nd and last. We had an incident on our unit that resulted in a maternal death. let me just say a few words
    previa (more incident after C/sections)
    acreta (more incident after C/sections with a diagnosed previa)
    percreta, increta procreta (have to have an acreat to have these)
    pt bleeding stat C/section within 10 minutes baby out mom basically bleeds to death can't stop bleeding. (tried for a long time)
    With increased c/section rates we WILL see more of this. Granted still won't be enough to raise the attention of the public unless someone famous dies but C/sections have risks. Risks that are not immediate. I don't think people truely understand the risks. Sometimes I don't think we as nurses understand the risks.
  3. by   LizzyL&DRN
    Quote from mugwump
    Granted I haven't read every response. I had a C/section with my first. (decels) a repeat section with BTL with my 2nd and last. We had an incident on our unit that resulted in a maternal death. let me just say a few words
    previa (more incident after C/sections)
    acreta (more incident after C/sections with a diagnosed previa)
    percreta, increta procreta (have to have an acreat to have these)
    pt bleeding stat C/section within 10 minutes baby out mom basically bleeds to death can't stop bleeding. (tried for a long time)
    With increased c/section rates we WILL see more of this. Granted still won't be enough to raise the attention of the public unless someone famous dies but C/sections have risks. Risks that are not immediate. I don't think people truely understand the risks. Sometimes I don't think we as nurses understand the risks.
    :yeahthat: AMEN TO THAT!!! I have seen this situation a couple of times and it is one of the scariest things that can happen in OB. We had a pt that was prev c/s x 1 or 2(can't remember exactly). Was losing the baby at 20-22 weeks, so they let her go vaginally.....They couldn't get the placenta out so started a D&C and all Hell broke loose. She got I think 9 units of blood, an emergency hysterectomy. She almost died from all this and lost her baby and uterus... SO SAD!!! This is a rare complication but we will definetly start seeing it more since the c section rate is rising. I think the national average is about 30%....It will be interesting to see how high it goes in the next 5 years.... And the maternal/infant mortality rate.
  4. by   33-weeker
    Yea... and uterine rupture (greater chance with each c-sec.) doesn't always happen during labor. It can happen at home... at the mall... you get the idea.
  5. by   jpetrunis
    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.
    Thank you for that comment, judy. After reading the rest of this thread I was wondering if anyone else felt this way.
  6. by   obnurse93
    I also have difficulty dealing with those who have chosen to elect a primary c/s. If they were really being informed properly, shouldn't their provider have impressed upon them that this is major surgery and also what how the risks increase with future pregnancies? I think everyone patient and provider are looking for an easy way out in their very busy lives regardless of consequences whether immediate or long term. Wouldn't it be nice to choose the date that your baby will be born, or work it around your schedule so as not to interfere with your life. Physicians don't want to be up all night with a laboring patient, they have office hours in the morning. I believe that good labor support, education of the patient and her significant others may make a difference, but our society seems to agree with the mentality "let's get in get it done". There are risks in all pregnancies and births, but why shouldn't we take the most natural route to get there?
  7. by   mom23RN
    You know the way to put an end to "vanity c-sect" or for those who are just afraid of labor? Get teh insurance companies to stop paying for them. I bet that would nip it in the bud. I wouldn't be surprised if they're actually thinking about it and if it's not for a medically necessary reason, you get a c-sect - you pay for it. Probably the docs will stop pushing them as well.

    I think one of the other things they're doing is really pressuring mom with ultrasounds. I have had two friends who were told their babies were "very large" by ultrasound. One a first-timer. They told her that the baby was measuring over 8 pounds BUT this could be off and she could be almost 10! (I reminded her that the "off" part works the other way as well and she might only be 7 pounds). Well... it was New Years Eve morning and guess who was "talked into" having a c-sect?? yep... baby was just over 7 pounds. :trout: Almost identical thing with the other friend.

    We'll see in the next few years what insurance companies have to say. If it's vanity, most of them don't pay for plastic surgery, why would they pay the needless expense of a c-sect?
  8. by   subee
    Quote from jpetrunis
    Thank you for that comment, judy. After reading the rest of this thread I was wondering if anyone else felt this way.
    Gee, patients should have the "right" to dictate medical care? We should do elective sections because the its the patient's choice? Do we allow children to choose whether or not to lose part of a leg to sarcoma because they don't want the surgery? Someone has to set a line whether a choice is reasonable or unreasonable. It is unreasonable to assume that I will put you to sleep for your elective c-section because I know that you may be frightened of pain, emotionally or intellectual immature or maybe plain crazy, but I am obligated to "DO NO HARM". It is a moral imperative - not a whim. That's why I believe that physicians who perform elective sections are about as helpful as a boil on a butt and shame on their professional associations for not policing them better. Its a lack of self-policing among themselves that is partly responsible for the messy system we have now. We had to wait until the 20th century for evidence based practice?
  9. by   westies
    My 2 cents... I loved the anticipation of every night wondering "will this be the night". I work straight nights so figured that would be my time to start labor. Yes it was for both. As far as pain, my first was an emergency c/s for complete and breech withing 1.5 hours of arriving. My second was a VBAC. Although I was much more uncomfortable after my vaginal birth initially, the c/s was a much harder recovery over all. I was easily back to "normal" within a week. I still felt sore and wore out 3 wks out from my section. Thank goodness that was with my first because I would have had a 2 yr old at home with me second time around... Oh and not to mention I'm an NICU nurse who has seen more than her fair share of TTNB and PPHN from elective c/s. (does anyone else notice that they are doing them earlier as well?)
  10. by   obnurse93
    I think you are right about the insurance companies but remember the physicians are entering diagnosis that would allow for the procedure, how is their diagnosis disputed?
    I agree with you also about the ultrasound results. I was told by a MFM that my baby would be >9 lbs at birth, had me scared to death because my other three deliveries produced babies the were 7 lbs or under. It is very easy for all of these screening tests to provide data that would allow the physician to perform these c/s's because it is not an exact science, but the patient needs to be well informed of all that is possible without emphasizing the points that will scare the mother to have major surgery to deliver a baby.
  11. by   ak127
    Quote from 33-weeker
    Yea... and uterine rupture (greater chance with each c-sec.) doesn't always happen during labor. It can happen at home... at the mall... you get the idea.
    Gives me the shivers to think about that...

    Of course, pregnant women freak me out in general, hats off to you OB & NICU nurses, I couldn't do it! I did rotations in high risk perinatal and NICU that gave me ulcers. I can't look at healthy, normal, pregnant women anymore without seeing "fetal demise at 8 mos", "hemmorrhage", "miscarriage", "twins, both brain damaged", "crying NICU mom" stamped across thier foreheads. It was really traumatizing for me. Give me a cancer patient any day of the week over a pregnant woman!
    While I am still in school, I am thinking about doing this volunteer doula program. They train you, then you provide free services to help support moms though it that otherwise wouldn't have anyone. I think it would be great for the moms (don't worry, I can always hold it together in front of my patients) and might help me get over my irrational fear of pregnant women to see a few healthy uncomplicated births! Otherwise I may never come off birth control pills!
  12. by   judyblueeyes
    Quote from subee
    Gee, patients should have the "right" to dictate medical care? We should do elective sections because the its the patient's choice? Do we allow children to choose whether or not to lose part of a leg to sarcoma because they don't want the surgery? Someone has to set a line whether a choice is reasonable or unreasonable. It is unreasonable to assume that I will put you to sleep for your elective c-section because I know that you may be frightened of pain, emotionally or intellectual immature or maybe plain crazy, but I am obligated to "DO NO HARM". It is a moral imperative - not a whim. That's why I believe that physicians who perform elective sections are about as helpful as a boil on a butt and shame on their professional associations for not policing them better. Its a lack of self-policing among themselves that is partly responsible for the messy system we have now. We had to wait until the 20th century for evidence based practice?

    The difference in your examples are adults v. children. Also, what is reasonable to one person is not to another. Why should I let you dictate how I will have my children? Are you coming to my house to raise them, too? And why did you give me a general? Because you didn't like my choice of delivery? I though it was my birth.
  13. by   inanna
    We have just started doing elective c/s in the past year or so at my hospital. We had a new doc to come in and I guess where he came from he routinely had done them. I must admit that I have mixed feelings about this subject. I can't blame anyone for not wanting to hurt. But c/s have risks too. It is major surgery. If I had been given the choice, I would have probably have chosen a c/s too. But, in 1996 I didn't have that choice. I also didn't have the choice to get an epidural. My hospital only did intrathecal, and I progressed too fast. I begged for a c/s, at the time. Although, I did end up delivering vaginally with a 4th degree. Not at all fun. If I had to go through it again, I would probably choose to labor, if I could have an epidural, that is, and it work!

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