Elective Primary C/S

  1. 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.
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  2. 91 Comments

  3. by   tntrn
    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.
  4. by   LizzyL&DRN
    After having two children vaginally, the first causing a 4th degree lac I sometimes wonder why I didn't have an elective c section. Now I get to worry about the future problems I may have as far as incontinence etc. And from what I hear its pretty likely that someday an A & P repair will be in my future. I think wanting an elective c section because you're scared of labor is really quite stupid. Do these pts think major surgery doesn't hurt? However, if a pt doesn't want a vaginal birth because they don't want future problems w/ incontinence I can understand that. I know not every woman has this problem, but vaginal births do increase your risk.
  5. by   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.

    No one was more afraid of an epidural than me...I feared that more than anything else. However, I feel I was blessed with a good doctor because it didn't hurt more than any other shot I had ever had in my life...it was just the thought of it. A few seconds and it was done. The staff was extremely supporting, the RN told me to give her a big hug, they put a warm blanket on me, and it was overwith before I knew it.

    I was very excited and said, "That's it?! It's over?".

    I had an emergency section, but I never would have allowed a doctor to do one unless they were 100% sure there was no alternative. The hardest part was being awake and not knowing what was going on. I was so afraid she wasn't going to make it.

    However, my cousin, who was equally afraid of childbirth, had a 24 hour labor, epidural wore off, and she swore she would never go through that again and she never did. She also had to have multiple stitches.

    But getting completely knocked out? No way...that compromises the infant too much. That needs to be the last resort.
  6. by   BSNtobe2009
    [quote=LizzyL&DRN;1934498However, if a pt doesn't want a vaginal birth because they don't want future problems w/ incontinence I can understand that. .[/quote]

    Even after a c-section it can still happen. After I had my daughter every time I sneeze or cough hard I dribble :smilecoffeecup:
  7. by   Jokerhill
    I really like the part where they say they don't want to have the pain of labor! If they could see what I see the pain of labor would pail. I love the part when both the Doc's grab lean back and PULL. Just that one manuver has got to hurt for weeks. The moms can't even walk they just do the shuffle step. They still have alot of pain is just the next day. In other words they don't get out of nothing.
  8. by   santhony44
    I heard a radio program just this past weekend that talked about elective c-sections with first babies and was just astonished that it happens.

    My first son was born by c-section due to failure to progress- I was induced on my due date because of gestational diabetes. I was able to have an epidural and stay awake (I begged the anesthesiologist not to put me to sleep!), he was healthy despite the cord around his neck (twice).

    We did schedule my second one; the doctor reluctantly offered a VBAC but was relieved I declined. I was again awake, he had the cord around his neck as well. Also healthy.

    They are 20 and 16 now and I would never have dreamed of asking for a convenience section, and would not have been given one had I asked. At that time I never heard of such a thing. You got a section for things like breech or transverse presentations, failure to progress, fetal distress, etc. etc. Repeat sections were pretty common but the first one you got for a medical reason.

    I was not afraid of the epidural. I was deathly afraid of general anesthesia. I had seen and taken care of severly brain-damaged patients from anesthesia for things like TURPs and hernia repairs. I wasn't going to be put to sleep unless it was an emergency. (I have since had general anesthesia 3 times and did fine).

    Aren't morbidity and mortality rates higher for sections than for vaginal deliveries? Why has it become acceptable to run a greater risk of complications for convenience?

    And as someone else pointed out, a c-section is abdominal surgery. You do have pain! Try coughing without having a chance to split the incision- I thought my insides were going to be on my lap! I also distinctly remember the bloating and miserable gas pains, too.

    I don't regret having sections, as I think my boys might have had more problems if the cord had tightened during labor, but doing one solely for convenience makes no sense at all.
  9. by   SmilingBluEyes
    Thank you, Britney Spears. UGH.
  10. by   Gem97
    I can agree about the epidural, I had one with my first and not with the last two labors. Just read a great article at work from NIH regarding this issue. At work we are just suprised when someone does come in with spontaneous labor, and delivers vaginally without complications since majority of our vag deliveries are d/t Inductions.
  11. by   MemphisOBRNC
    "Thank you, Britney Spears. UGH."
    :yeahthat:
  12. by   mitchsmom
    Aren't morbidity and mortality rates higher for sections than for vaginal deliveries? Why has it become acceptable to run a greater risk of complications for convenience?
    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.
  13. by   louloubell1
    Quote from tntrn
    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.
    OK, I'm sorry, not meaning to flame you, but when it comes to inducing general anesthesia on an obstetrics patient, it is obvious that you need some education. This is simply and strictly for your edification:

    General anesthesia is risky business for c-section for several reasons. Did you know that the highest incidence of failed airway happens in the pregnant patient? Did you also know that the pregnant patient is always a "full stomach",putting them at serious risk for aspiration upon general anesthesia induction? And because of the respiratory system changes that occur with pregnancy (i.e. decreased FRC and increased O2 consumption), the parturient patient desats quickly upon anesthesia induction. Furthermore, because inhalation anesthetics promote uterine relaxation, they contribute to maternal hemorrhage. Not only do these factors add up to a significant life risk for the mother, they combine to make general anesthesia risky for the baby. Barring contraindications to neuraxial anesthesia, only emergent C-sec patients should be going to sleep.

    It might also interest you to know that general anesthesia for c-sections carries one of the highest rates of recall under anesthesia (right up there with traumas and heart surgery).

    Anesthesia providers don't "pressure" moms to have a "needle stuck in their back" to make our own lives easier.
  14. by   LDRNMOMMY
    Quote from RNLou
    OK, I'm sorry, not meaning to flame you, but when it comes to inducing general anesthesia on an obstetrics patient, it is obvious that you need some education. This is simply and strictly for your edification:

    General anesthesia is risky business for c-section for several reasons. Did you know that the highest incidence of failed airway happens in the pregnant patient? Did you also know that the pregnant patient is always a "full stomach",putting them at serious risk for aspiration upon general anesthesia induction? And because of the respiratory system changes that occur with pregnancy (i.e. decreased FRC and increased O2 consumption), the parturient patient desats quickly upon anesthesia induction. Furthermore, because inhalation anesthetics promote uterine relaxation, they contribute to maternal hemorrhage. Not only do these factors add up to a significant life risk for the mother, they combine to make general anesthesia risky for the baby. Barring contraindications to neuraxial anesthesia, only emergent C-sec patients should be going to sleep.

    It might also interest you to know that general anesthesia for c-sections carries one of the highest rates of recall under anesthesia (right up there with traumas and heart surgery).

    Anesthesia providers don't "pressure" moms to have a "needle stuck in their back" to make our own lives easier.
    :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.

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