Elective Primary C/S

Specialties Ob/Gyn

Published

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 having a general anesthetic because "I don't want a needle poking me in my back". I find myself getting fustrated with these pt's, I don't like to feel that way towards them. A small percentage of these young ladies don't even know why the Doc has even scheduled them for a primary c/s, and then the advocate comes out in me and when the patient asks the doctor for a trial labor, the doc talks them out of it. It really frustrates the hell out me. What do other's feel about this new trend? I really need to see if this is occurring more frequently nationwide or if this is a local issue. I understand if there is true CPD, breech, or maternal complication that would require a primary, but too many times these babies are vertex and average birth weight that are delivered. It's one thing when a pt has gone through labor and is FTP, failure to descent, or fetal distress that send them packing into an OR, but this Primary elective issue has just grated my nerves. My other co-workers are frustrated as well and the response from my peers is "we just have to accommadate the docs order". Please share some insight regarding this issue.

I really can't explain my fear of epidurals. We all have irrational fears in life, and that just happens to be one of mine, pure and simple. I am also overweight and have scoliosis. When I bend over, you sure as heck don't see a nice spine poking out. It won't be an easy poke. I've seen many epidurals placed in L&D and many spinal taps in the NICU - I can't stand watching either of them.

I also have scoliosis and am overweight, but both my epis were just great, and it wasn't any more difficult for the docs to put them in. It just goes up higher. You'll be fine if you end up needing one.

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Primary elective c/s, money, money, and the timing goes the doctors way.

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Specializes in Telemetry, Nursery, Post-Partum.
I really can't explain my fear of epidurals. We all have irrational fears in life, and that just happens to be one of mine, pure and simple. I am also overweight and have scoliosis. When I bend over, you sure as heck don't see a nice spine poking out. It won't be an easy poke. I've seen many epidurals placed in L&D and many spinal taps in the NICU - I can't stand watching either of them.

I'm not pregnant, but I totally, 100%, have the same fear of epidurals. Its not the thought that it will hurt going in, its just the whole idea. I hate to watch them. I hate watching spinal taps too, fortunately I haven't had to see alot of those. Its very difficult to explain this fear, it just totally creeps me out. You are not alone!

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Specializes in CRNA, Finally retired.
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.

Anyone who has worked in OB knows that some women are not competent to make decisions during labor. Let's say that you've already had two sections and now you want general anesthesia for the third. My first obligation is, as I said, do no harm. We know that you have a lot of scar tissue in there from the previous two sections and this is not going to be a quick delivery...ergo the baby will suffer the effects of the induction drugs.

Your baby's health is higher priority than your desire for general. We have TWO patients to take care of - its not all about you. I've never met a women who insisted on a general - never in 22 years. Many times I've given a general to a patient who would do better with a spinal - for a non-obstetrical procedure- but I always chart that the patient was advised a spinal but refused. I'd much prefer to be in court defending myself against a woman whining that she didn't get her general than a women with a child with permanent disability. Has absolutely nothing to do with how you want to raise your children - my job is to give you something to raise. (Oh, and its not just YOUR birth - its your baby's too).

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i had an emergency c-section with my 1st, due to her being breech( she was actually stood up) and also going into distress. i had epidural which did not work fully so ended up with a ga. i must agree that sections take longer to get over. my second was a normal delivery, felt much more able to cope mentally and physically. at the end of the day you would do what is best for your baby`s health. during my nurse training i work on placement on a labour ward and had seen epidurals being given and always said that i would never have one. but on being told i needed an emergency section, i elected to have epidural as i felt it was preferable to a ga, only to end up having it anyway. ha! ha! just my luck

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Specializes in L&D telephone triage.

There are several issues that bother me with this subject.

C/S is a MAJOR abdominal surgery. These are real risks--bleeding, infection, damage to other organs, hysterectomy, and DEATH. Death is also the worse risk of anesthesia.

Labor is painful. Yes, lawyers are involved so much in our sue happy society that we cannot provide patient care. We are providing lawyer resistent care. We can do a lot to help ease pain, but again, labor is just that--LABOR. Hard work is painful. Someone needs to explain this to people before they every have sex. You don't get something for nothing.

The main reason epidural medication is used, it because it is the most relatively safe anesthesia to use. Let's stay with the path of lease law suit risk.

Our society is so me, me, me conscious that we don't think about the baby. I don't want to hurt. I don't want stretch marks. I want to decide what day I deliver. What about the child that is going to turn your nice, neat little world upside down. That's what we need to think of. What's best for the baby. There's a reason we were made to have babies. It is a natural process.

I work in a high risk unit. I have traveled. Let's not treat everyone like they are sick or a procedure to do. Let's let nature do what God intended unless he let's us knowhe would like us to help him.

I have done it with and without epidurals. With, when induced for being that 17 year old first time mother with out of the world blood pressures. That was 25 years ago when no one went with you if you were not married. I don't think any of us has the upper hand on being scared. That epidural for a petrified kid wasn't so bad compared to the pain of having a 8# 10 oz baby with out an epidural. The amazing thing is, anmesia comes into play when you hold that child. How on earth do you think we have more than one child.

We need to be an advocate for out patients--mother and child. Yes, there are risks with any delivery. But, I have seen death more with C/S than lady partsl delivery.

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That's what I don't understand about this whole thing - there IS pain with c-sections. It's major abdominal surgery and there is post-partum pain. It's just trading one pain for another, in my opinion. To me, avoiding pain doesn't seem to be a reason to choose surgery - it's going to hurt one way or another.

I had drug-free labors twice. The first child, a 9 lb. daughter. I've never experienced a c-section, but I've watched grown women cry from the post-op pain. No thanks.

I'll take labor over major abdominal surgery any day. At least labor is intermittent and temporary. It's over when the baby is born. I wanted to be comfortable and able to enjoy my newborns.

(Hint: The secret to a comfortable vag. recovery is to choose a caregiver who won't do a 'lady partsl cesarean' -- meaning cut you from end to end -- or let you tear. The midwife that delivered my 9 pounder had delivered 300 babies only giving 3 episiotomies, and she had never had anything worse than a second degree tear.)

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some of these young ladies act like they are the first to ever have a baby come out of "there." like it's completely unheard of and why have they been chosen to deliver a child that way. you're not the first and won't be the last. get over it. if babies weren't supposed to come out that way, they wouldn't.

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