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C/S as a birth option vs need

I have been reading more articles about women who elect to have cesarean sections even when they are not medically or obstetrically necessary. I would love to hear from my OB peers as to their opinion on this. Does the patient have the right? Is it a safe practice? Are you working anywhere where the OB's are routinely offering C/S?

Thanks for your input. :rolleyes:

it is not done where i work. Our rate is quite high at 23-24% but our doctors do not offer csection as an option unless for a repeat (after prior csection) or if the baby is expected to be unusually huge with a woman's pelvis measured very small. This is considered more medical, tho, not elective. No one is offered elective first-time csection w/o medical indications.

Since Acog gave the Ok for elective c/s we seem to have a lot more.. waiting for the stats actually/...\My opinion???

I think it's crasy!!!!

Ginny SNM RN DOula

One of our docs really pushes them and daily says why would you want to have a vag delivery all your parts will fall out later in life. They don't tell these ladies about the pain after and recovery of major surgery. I had 3 natural and #4 c/s for breech. I thought I had a high pain tolerance with nothing for the 3 the c/s was awful for months after. This doc will tell patients that the baby is big (then they come out less then 7#) This man is scared to death of shoulders. He likes c/s cause he can be done in 10 minutes on his schedule instead of waiting. Breaks water when they are a F/T at 7am then by 5 when they are only 4 is ready to cut after office hours.

I think offering a cesarean as an option for keeping your "innards" in place and pleasing your husbands . . :angryfire is just irresponsible.

Having said that, I had three vaginal deliveries and one emergency cesarean with my last and the truth I was hoping to avoid labor and have a cesarean. I didn't want an emergency though. I ended up with one and after finding out my son was ok, I liked it better than a vag delivery.

I know, I'm weird. I don't like the feeling of being out of control of what is happening to my body and labor pains gave me this otherworldly weird icky feeling - not to mention the pain.

So, my cesarean was no big deal.

steph

P.S. All my innards are right where they are supposed to be and my husband has no complaints. :)

It's starting to be the next big thing in my area (although NOT my hospital!) Last fall there was an ad in a local paper for a doc in a solo practice at another area hospital offering elective primary sections (and promising a free ultrasound with every prenatal appointment!) Someone cut it out at work and posted it; we were so shocked since that is totally not the culture at our hospital! As an example, last spring or summer, I came into work and found our chief of OB flipping through a pile of books and journals, trying to figure out if it was ethical to offer a patient a C-section on demand. This patient, who I ended up taking, was from another culture where C/S are common. At her first prenatal appointment she requested one and was advised that this practice, this hospital could not accomodate her request; she kept pushing for it but stayed with the practice. Ended up stalling at 5-6cm in labor, spiked a temp, baby got tachy, and finally got the C/S she had wanted. (I often think her labor stalled- her contractions petered out and even with pit we couldn't get her back into an effective pattern- because she didn't want to labor or deliver vaginally; mind over matter and all)

Anyway, someone mentioned recently in a meeting that the other hospitals in the area were planning to start offering elective primary sections. I fear that there's going to be a lot of pressure for our hospital to follow suit. The larger of the 2 practices catching babies at my hospital will continue to resist the trend I'm sure, but I'm afraid the smaller practice- which already has a higher section rate- will press the issue. We have a reasonably low primary section rate, 11-13%; since we cannot offer VBACs our overall rate is around 21%. I'd hate to see that go up. We have a wonderful culture that is very supportive of natural, intervention-free births. But it seems like women are less trusting of their bodies, no longer wanting to take an active role in shaping their own birthing experiences. I don't see it so much in my own unit as I do in the freebie pregnancy magazines that are always floating around, on TV, and in the Amercian culture at large. Knowing how hard the midwives worked to foster this culture at work, their long years of proving "normal childbirth" to the now-retired old school docs and reeducating the newer docs as they came along- I would hate to see it all go away.

I strayed a little there... to the OP: no, I don't think it's safe, responsible or ethical practice to offer medically unnecessary C-sections. I think many women who request them do so because they are misinformed and think a C/S is easier, safer, and less painful. We women fear the natural labor process, are afraid of our bodies, and distrusting of our own strengths, IMO largely because from the moment we realize the stork doesn't bring the baby we are bombarded with horror stories and negative and/or scary portrayals of childbirth in the media.

I find this very disturbing. A cesarean is not minor surgery!!! There are real risks involved and I can't see how offering that when it isn't needed is responsible.

Also, for those whining about the cost of healthcare, this is a biggie. You have to pay the anesthesiologist, more nurses, use an OR, mom stays in an extra 2 or 3 days...

I find this very disturbing. A cesarean is not minor surgery!!! There are real risks involved and I can't see how offering that when it isn't needed is responsible.

Also, for those whining about the cost of healthcare, this is a biggie. You have to pay the anesthesiologist, more nurses, use an OR, mom stays in an extra 2 or 3 days...

I, too, find this trend a scary one (although we have no docs who do this) although I can think of one of our women OB's who would love to ee that happen.

I agree that women think a section is easier and I am pretty sure in this climate these days, that the docs are not really giving informed consent about the real risks associate with c/s (surgery in general) although our OB/CNM practice does do a good job with risks.

USA987, MSN, RN, NP

Specializes in Behavioral Health.

I've only seen a handful of elective sections at my facility, by one OB group only. The way this group practices scares me to death (and I am still fairly new to L&D!). One elective section ended up with an enormous hematoma at the incision site requiring a return to the OR. She was left with a GAPING open wound that she will have to pack and dress daily for months. Bet she wishes she would have at least had a trial of labor!!!

I've only seen a handful of elective sections at my facility, by one OB group only. The way this group practices scares me to death (and I am still fairly new to L&D!). One elective section ended up with an enormous hematoma at the incision site requiring a return to the OR. She was left with a GAPING open wound that she will have to pack and dress daily for months. Bet she wishes she would have at least had a trial of labor!!!

This scenario is a PERFECT example of why elective primary c/section should not be allowed. I'm sure docs don't tell these stories. Yuk!!

I have heard many women comment that they would prefer a c-section to a vaginal delivery anyday, and I have to say, it baffles me! I can't even imagine why anyone would want a c-section if it was not deemed a medical neccessity. I had to have one with my first because my labor was induced and I wasn't progressing. The pain was horrendous, and I couldn't care for the baby myself for weeks. This time I was really looking forward to having that birthing experience, but my OB won't go for it. :o I really feel like I'm missing out on one of life's great experiences. Anyway, I have a few more months to change her mind. :chuckle

I guess the grass is always greener....

I have heard many women comment that they would prefer a c-section to a vaginal delivery anyday, and I have to say, it baffles me! I can't even imagine why anyone would want a c-section if it was not deemed a medical neccessity. I had to have one with my first because my labor was induced and I wasn't progressing. The pain was horrendous, and I couldn't care for the baby myself for weeks. This time I was really looking forward to having that birthing experience, but my OB won't go for it. :o I really feel like I'm missing out on one of life's great experiences. Anyway, I have a few more months to change her mind. :chuckle

I guess the grass is always greener....

I've taken care of many moms after cesareans and they are all different. Some bounce right up and out of bed - seems like these are usually not the primary cesarean but subsequent ones. Some take more time to recuperate. I was able to breastfeed without problem and my son stayed in my bed with me except for assessments when he was taken to the nursery. I did have to have help to lift him out of the bassinet if I was in bed. And I was amazed at how such a little thing as clearing your throat had something to do with your abd muscles. I initially had a MS PCA but the second day went on Darvocet. The best thing was the anti-gas meds - gas hurts! :) I went home after 3 days and the women in my church brought meals to our home for a week, which was wonderful. I did all the baby care though. I even went to my husband's 30th high school reunion - although I was still taking pain pills and walking funny. ;)

I hope your next one will be less painful for you and you recuperate quicker.

Best wishes.

steph

HvnSntRN

Specializes in Foot Care.

We're seeing an increase in elective C/S for primips recently too. It is not endorsed by the SGOC, but we do have OBs that really encourage them - and a couple of docs who have had these elective C/S themselves. The commonality that I seem to notice among this cohort of patients is that they are accustomed to things being done their way, all the time. Waiting on a baby to pick his or her birthday seems archaic to them when they can just schedule their entire life with a palm pilot. These patients are some of the most demanding, impatient women I have ever encountered. I often wonder how they will ever cope with teething babies or earaches, or anything else that is not carefully orchestrated and recorded in their electronic diaries in quadruplicate.

I have heard many women comment that they would prefer a c-section to a vaginal delivery anyday, and I have to say, it baffles me! I can't even imagine why anyone would want a c-section if it was not deemed a medical neccessity. I had to have one with my first because my labor was induced and I wasn't progressing. The pain was horrendous, and I couldn't care for the baby myself for weeks. This time I was really looking forward to having that birthing experience, but my OB won't go for it. :o I really feel like I'm missing out on one of life's great experiences. Anyway, I have a few more months to change her mind. :chuckle

I guess the grass is always greener....

Couold you look for an OB or an obstetrical practice that allows VBAC's?

mitchsmom

Specializes in OB, lactation.

If anyone is in a position to use them, here are some good resources from Maternity Wise. "Maternity Wise is the Maternity Center Association's long-term national program to promote evidence-based maternity care":

What should I know about cesarean section?

http://www.maternitywise.org/mw/topics/cesarean/

How can I prevent pelvic floor problems when giving birth?

http://www.maternitywise.org/mw/topics/pelvic-floor/

Should I choose VBAC or repeat c-section?

http://www.maternitywise.org/mw/topics/vbac-cesarean/

They also have:

How do I choose my caregiver?

How do I choose my birth setting?

How do I get the labor support I need?

How will I cope with labor pain?

I've taken care of many moms after cesareans and they are all different. Some bounce right up and out of bed - seems like these are usually not the primary cesarean but subsequent ones. Some take more time to recuperate. I was able to breastfeed without problem and my son stayed in my bed with me except for assessments when he was taken to the nursery. I did have to have help to lift him out of the bassinet if I was in bed. And I was amazed at how such a little thing as clearing your throat had something to do with your abd muscles. I initially had a MS PCA but the second day went on Darvocet. The best thing was the anti-gas meds - gas hurts! :) I went home after 3 days and the women in my church brought meals to our home for a week, which was wonderful. I did all the baby care though. I even went to my husband's 30th high school reunion - although I was still taking pain pills and walking funny. ;)

I hope your next one will be less painful for you and you recuperate quicker.

Best wishes.

steph

Thank you so much for the well wishes, steph! It is very comforting to know that I might recuperate quicker from this 2nd c/s. Maybe my slow recovery had something to do with the fact that I wasn't even in the hospital one full day after the c/s? It was performed at 9:05 pm and I was discharged at 11 a.m. the next morning. I still haven't figured that one out.

Bets, my OB does normally offer a VBAC, but since I'm overweight she thinks that if my uterus *did* rupture during labor, an emergency c/s would be too hard on me. So I guess the only thing to do is get in better physical shape and hope for a vaginal delivery next time. :) I'm not quite sure how likely it is that a uterus would rupture though... maybe some of you OB nurses know?

Thank you so much for the well wishes, steph! It is very comforting to know that I might recuperate quicker from this 2nd c/s. Maybe my slow recovery had something to do with the fact that I wasn't even in the hospital one full day after the c/s? It was performed at 9:05 pm and I was discharged at 11 a.m. the next morning. I still haven't figured that one out.

Bets, my OB does normally offer a VBAC, but since I'm overweight she thinks that if my uterus *did* rupture during labor, an emergency c/s would be too hard on me. So I guess the only thing to do is get in better physical shape and hope for a vaginal delivery next time. :) I'm not quite sure how likely it is that a uterus would rupture though... maybe some of you OB nurses know?

Ok, that is nuts to discharge you that quickly. I completely understand your rough recovery.

Sorry that had to happen. I don't get it either.

steph

wannabemw

Specializes in Lactation Ed, Pp, MS, Hospice, Agency.

I have heard many women comment that they would prefer a c-section to a vaginal delivery anyday, and I have to say, it baffles me! I can't even imagine why anyone would want a c-section if it was not deemed a medical neccessity. I had to have one with my first because my labor was induced and I wasn't progressing. The pain was horrendous, and I couldn't care for the baby myself for weeks. This time I was really looking forward to having that birthing experience, but my OB won't go for it. :o I really feel like I'm missing out on one of life's great experiences. Anyway, I have a few more months to change her mind. :chuckle

I guess the grass is always greener....

You WON'T change her mind. Find a new OB or CNM that will allow a VBAC... even if u have to pay out of pocket! Childbirth is a life-changing experience! Your gut is telling u something ain't right... listen to it! Listen to yourself and TRUST your instincts and feelings...

Remember, u r paying for her services, not her for yours!

Find a CNM or LM! Oh yeah, and have a happy birth!

~MJ

You have to find a FACILITY that will allow VBAC, not just doctor. Increasing numbers of hospitals are NOT allowing this nowadays. Just be aware of that and begin your search now. You might not find it easy to find one....ours is the only facility for miles that does, and we have had people travel 3 or 4 hours for the VBAC experience we allow. It's a risk management thing, naturally.

I can't believe we have come to a time when women are so freaking shallow that they are so busy trying to please theire husbands. To maintain one's body? Having a c-section so a woman's vagina has a smaller opening to please a man or to prevent a uterus from prolapsing later in life (sorry for the graphic image). If that's how these women feel, how about not having children. Child birth is not necessarily pretty, the purpose is to have offspring. This concept sickens me.

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