Why a C-Section?

Specialties Ob/Gyn

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Hi everyone, I was just wondering why so many women are choosing to undergo ceasarean delivery without even a trial of labor? Don't they realize it is a major abdominal surgery and they will be in severe pain for several weeks? I know that it is a very necessary procedure sometimes, but it just seems so overdone and unnecessary sometimes. I'd love to hear from you!

I might get flamed for this, but I am going to choose a C-section if and when I have children. I would simply prefer it to lady partsl birth- having witnessed several of each while in nursing school. Fortunately, my insurance will pay because I have a lumbar spinal fracture as well as a tilted uterus, but I would pay for it if I had to. Maybe I'm just a wuss.

Lori

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Specializes in Gerontological, cardiac, med-surg, peds.

A good article:

http://pregnancytoday.com/reference/articles/electcsec.htm

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When you look at the statistics and compare the recovery time/diffaculty of C/S vs Vag delivery its really hard to argue that one is better then the other.

Add to that the fact that their is less risk and uncertanty to the baby and its hard to argue for vag delivery over C/S. I have to belive that their is some physiological benifit to vag delivery but I cant say that I know of one that outweighs the statistical probability of complications with a vag delivery=(

I do know that when takeing care of patients who have a vag delevery, especialy non medicated I see a change in them. They gain something threw the process. However there are also those that have a vag delivery and all it does is traumatize them.

I agree with smileing it's a symptom of our self centered, instant gratifacation gereration. Some people just dont see any value in the experance of childbirth.

I don't really have an opinion on which way is right or wrong or better. I just know I don't like doing elective C/S, sure if someone needs a C/S Im very glad that we can do that for them but given the choice Id rater care for laboring women. I mean if I wanted to work the OR all day I would work in the main OR.

ACOG changed their stand on elective C/s about a year or 2 ago. Dont think for one molment they did this to advocate for a womens right to choose. They did it becsue it will decrease lawsuits, slightly increase profits and allow for schedualing of an OB's day.

just think about the benifits to OB's and hospitals.

right now 1 RN can take care of 2 laboring women and that takes them up for most of their shift. If patients have elective sections 1 RN could circulate and recover 4 -7 C/S in 1 shift, if you had 1 circulating and 1 recoveing you could decrease your staffing even more. Hospitals can charge 2x what they do for a vag delvery for a c/s.

The OB will get less lawsuites due to bad babies becuse even if the baby comes out with problems the lawers cant blame it on miss manged labor if there wasent a labor. They can schedual C/S to fit their schedual and be home to eat dinner on time. All that and they get to charge a bit more.

The day is comeing when you will come to work and circle the OR all day.

Like I said I can't say that it's wrong for someone to choose a c/s I just know I will miss laboring paitents when the day comes that we have a 90% c/s rate like other countries

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Specializes in Gerontological, cardiac, med-surg, peds.

Another great resource:

Simpson, K.R., & Thorman, K.E. (2005). Obstetric "conveniences" - Elective induction of labor, cesarean birth on demand, and other potentially unnecessary interventions. Journal of Perinatal & Neonatal Nursing, 19 (2), 134-144.

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Its funny that this comes up again because just yesterday I was talking to a former coworker who was debating this very topic. I personally think that when my time comes to have a baby, I may have an elective c/s. While some say it is vain, I don't really know - but what is so vain about it?

I have no problem with people that would prefer to have one either. I am there to help with their delivery process whatever way suits them..... I will be their for the natural labor patient in our whirlpool who refuses an IV and wants minimal monitoring just like I will be their for the woman who wants a c/s.

I do agree that often times when a women labors and deliveries lady partslly there is an immediate change in them. However the accomplishment is more the beauty of bringing new life into the world and becoming a parent. It may be less evident initially with the c/s baby because the mother is also being operated on. But the empowerment is taking on the role of being a mother - not what hole your kid came out of.

Nature did make us to have babies lady partslly. However it is not that simple. If it were - we wouldnt need L&D units and nurses, obs, or fetal monitors. Women wouldnt die after childbirth, they wouldn't tear a new one, they wouldn't throw pulmonary embolisms, babies wouldn't have thick mec and aspirate and end up tubed, they wouldn't need forceps, and there would never be shoulder dystocias.

I think a patient who says they don't want to have labor pains needs to be educated on the pain from a c/s. But I do think women should have the ability to choose what way they want to deliver. It is not vain to say that I do not want to have urinary problems for the rest of my life. My mother and her mother and her mother all had that because of our genetics and I don't want it. It is not vain to say I know this is a big baby and I don't want to labor and wind up getting cut anyway. You never know who is going to have good outcomes. There are predictors but there is so much unknown. Just yesterday I had a G1 deliver a 10 lb 8 oz baby with no tears. She is 4 11. The patient in the next room also a G1 who had better pelvic symmetry and came in at complete/9 had to get a c/s for second stage arrest and her baby was just under seven lbs. You just never know. lady partsl deliveries do very much have such an essence of unknown. There are many bad outcomes. That is not to say the c/s do not have risks. They certainly do. However, there is a much higher degree of controlled risks in a c/s vs a lady partsl delivery.

I do think that it is something that is becoming more commonplace. Right now there is only one or two doctors who do this that I know of - but it will become more common. It may increase the c/s rate signifigantly - but I don't think it will be as high as some imagine. As a result of more elective c/s there will probably be less c/s after laboring type scenarios. In addition, there are still many, many women who would rather have a lady partsl delivery. If the patient is knowledgable of the risks and benefits of each way - I feel as though it is their right to be active in the decision making process.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Ah well I rest my case. I see right here an interesting sampling of women who have not had babies, yet who already have made up their minds to have elective csection. I understand your rationale, believe me. I have had my babies both ways, and I can speak about the difference in recovery etc, for both. But I won't lecture.

I just would urge anyone to be aware of risks. I have seen some mighty nasty complications from csection, too. Some I would rather not get into too much detail on here, like the loss of a uterus, severe peritonitis due to light nicking of a bowel , or women going home with a leg bag due to nicked and infected bladder. These things can happen at the hands of a very skilled and experienced surgeon, as I have seen them. Yep, these things do happen.

I don't blame you for wanting what you feel is best for you and your baby.I just wish people understood, csections are not like a simple day surgerical procedure you just choose for convenience. There are serious possible complications you are electing to expose yourself to. Believe me, after 8 years I have seem some horrific ones.

deb

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I also re-iterate. As you all have said, this will become more common. It is inevitible. And health care costs will continue to skyrocket. The trends indictate there will be as high as a 50-60% csection rate by 2020.

To be fair, then, I would say, a person electing to undergo a csection electively and without any documented or real medical necessity ought be asked to pony up for the expense incurred. There is a VAST difference in expenses incurred in csection delivery versus lady partsl delivery. I would rather not ask the public at large to have to bear the cost for elective procedures. Many of us can barely afford current insurance premium costs as it is. I think a review of csections cases and the reasons they are performed is needed.

On a separated but related note, I also think we ought be auditing our elective inductions and bring those under control, too. Elective inductions contribute to the high rate of csections being done today----unneccessarily oftentimes. I think pushing Mother Nature too far will cause her to push back.

I feel strongly, elective procedures need to be paid for by those electing to undergo them. I support others' right to choice, but I also am acutely aware of the co-existant responsibilities related to such choices.I think it's fair to ask others to contribute when such choices are made.

JMO, as always.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Thanks for the excellent resources, Vicky.

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Specializes in Ante-Intra-Postpartum, Post Gyne.

We live in a society where we get ticked off if we have to wait in line at the drive up for more than three minuets, where air popped pop corn machines look alien to us since were are so use to the microwave. Before we know it we will have drive up widows for our elective surgery's.

I think it is wrong,(You would have to have a darned to reason to get me to have a c-section...I have heard of plenty of story's of them being preformed when they did not need to be...like the doctor that needs to leave for vacation and labor is not progressing "fast enough") but until we step up and do something about it it is only going to get worse. We have to start with educating people. I have a friend that tells me all the time that I am crazy for being so gun-hoe about natural birth for myself. She told me, "I am going to have a C-section when I have children... C-section baby's are prettier, their heads are not all squished.":uhoh3:

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I think who pays for an elective c/s is an entirely different topic from whether or not a woman should have the right to decide in her delivery. I also don't think an elective c/s should be lumped together with a breast augmentation. And the word elective or maybe non essential can be left up to much interpretation. Insurance companies already have too much control on what doctors can do for the patients - I would hate for them to begin deciding when a c/s is indicated. Yes a c/s does accrue a higher cost - but a complicated 48 hour labor, second stage arrest, chorio, failed forceps trial and then delivery by c/s followed by a pp hemmorhage due to the long labor and chorio has an even higher cost.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I think when electing to have a csection, just as in the L/D situation---when, for whatever reason, a csection appears to be needed--- the decision needs to be collaborative. By that I mean, the physician and patient/family discuss the reasons a csection is indicated, and together, reach the decision to proceed. I also think there needs to be a medical need, not just "because I want to do it" as a reason.

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On the flipside of that coin, I also get frustrated with physician convenience as a very common reason. I have seen physicians lean VERY heavily on patients who are vulnerable and trusting, to proceed with this procedure, often ill-advisedly. I think that is horrible.

Yes, maybe a separate issue for you---but for me, is appropos: If we as the public are being asked to pay for these things, I would like careful and consistent auditing as to reasons WHY such elective procedures are being performed. I think we are fellow consumers and people being asked to pay for such things have that right.

Like I said, I believe very strongly in freedom of choice, but also I think we all must be reminded : along with choices come concommitant responsibilities, incurred both by medical professionals and the informed consumer.

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We live in a society where we get ticked off if we have to wait in line at the drive up for more than three minuets, where air popped pop corn machines look alien to us since were are so use to the microwave. Before we know it we will have drive up widows for our elective surgery's.

I think it is wrong,(You would have to have a darned to reason to get me to have a c-section...I have heard of plenty of story's of them being preformed when they did not need to be...like the doctor that needs to leave for vacation and labor is not progressing "fast enough") but until we step up and do something about it it is only going to get worse. We have to start with educating people. I have a friend that tells me all the time that I am crazy for being so gun-hoe about natural birth for myself. She told me, "I am going to have a C-section when I have children... C-section baby's are prettier, their heads are not all squished.":uhoh3:

And obviously your friend is giving silly reasons for wanting a c/s. But what about the person that is postdates and an unfavorable cervix? She has a 50/50 chance of needing to be sectioned after a failed induction That could be argued that they should labor first and see what happens - but that is an awful cavalier statement. And that too drives up the costs and the potential complications.

Yes a c/s has risks. But so does a lady partsl delivery. The risks are to both the baby and the mom. Why shouldnt a patient hear the risks and benefits of each one and have an active contribution to what should be done?

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