C-section vs. letting Mom go naturally

[JRP1120, RN]

Why am I hearing more and more of Dr.'s that ASK their patient's if they want to have a c-section instead of waiting and letting nature take it's course and baby comes naturally? I just don't get it!

I have a friend that is pregnant for the first time, isn't due for a few more weeks, has a very healthy pregnancy, no problems with her or the baby except that at last U/S, they guesstimated the baby is almost 9 lbs and has still not descended any and her cervix is still closed and thick. He offered her a c-section in a few days and she took the offer! Ugh! Ok, I may be old-school here in my thinking but I just don't see why any Dr. would offer that (besides they see it as easy money in their pocket) or why any woman would want that!! C-sections are major surgery to the body, as we all know. They are relatively easy in uncomplicated pregnancies but there is still more room for post-op infections, bleeding problems, etc...why can't Dr.'s just leave well-enough alone and let nature take it's course and let the woman's body do what it was made to do and has been doing for centuries...the baby will come out when it's good and ready, her body will tell her it's time to deliver that baby. She's not even at her due date yet, and it's her first baby, of course the baby hasn't descended yet and there's no dilation! Duh! Give it a few weeks, tell her to go walking, have sex, etc...geez!

I can totally understand if there were underlying circumstances here that would make a c-section the better option, but for my friend, there isn't any. It's not even a case where the Dr. doesn't think the baby will pass through the birth canal, he just gave her a choice, and being first-time pregnant and tired of being pregnant, she took the c-section. Baffles me! I'm an advocate for natural birth, as natural as medically possible of course and I'm all for women making decisions and all but to me, this is just ridiculous that a Dr. would suggest this to a first-time mom who will never even know if her body can deliver a baby naturally, and more than likely, she never will be able to experience that (even though I realize there are VBACs though it seems more and more Dr.'s are going away from those as well).

What do you all see in your L&D's? Is this practice normal when there are NO medical reasons for a c-section?

[darkangel83]

Generally the dressing is removed after about 24 hours. There is typically no dressing change unless there is a complication like a dehiscence.

Oops! Sorry, my message wasn't very clear! I meant dressing changes after a post-op wound infection. Our docs are re-opening more and more! Those are the dressing changes I am referring to! :)

[JRP1120, RN]

To the OP:

Do you think you could talk to your friend and try to educate her? Would that be out of order? Is it too late to do so? A c/s is going to be rough unless she has a person or person(s) to do a lot of helping while she is recovering. Everyone (including myself) doesn't have a whole host of family and friends to take care of everything while new mom rests.

I have already tried with no luck. She's made up her mind she has family ready and willing to help out, which will be good for her and a young husband that works a lot. I'm praying all goes well for her; I'm sure it will...I just wonder if by the time she's older and more mature and pregnant again, she'll wish she hadn't done this the first time around because now she's pretty much stuck with having c-sections. I think someday she will regret not educating herself or listening to her family and friends and letting her body do what it was made to do. It saddens me for her but I love her anyway! :heartbeat

[NicuGal, MSN, RN]

Ugh...and those are the kids we get in our NICU....the ones that the docs do the c/s on weeks before the due date without good cause! Luckily, the vast majority of our OB's don't do this and they are slowly weeding out the ones that do.

People like it because they get to pick their due date, etc. Just had one from another hospital that was like your friend, except the kid turned out to be under 7 pounds, 36 weeks and had severe RDS, ended up on the vent, nitric, pressors, etc. The mom was like, well they never told me this could happen...no darling, they never do.

I believe if they are going to do c/s earlier than the due date, they better be checking lung maturity....several of our docs do and that at least gives us a heads up!

[sgo13]

I totally agree with the person that recommended "The Business of Being Born". I watched it on Netflix also. It was very interesting.

[nohika]

Fear of litigation over what? A healthy mom more than likely lady partslly delivering a normal, healthy baby?

Unfortunately, it's the "less than likely" complications that make the docs paranoid. You can never 100% guarantee a risk-free delivery. It's all the commercials out there that are "Did your OB doc do XYZ while you were pregnant/was your baby born with XYZ? You may have a case to sue! Please call, blahblah". It's hard for them to assume when that one assumption could accidentally land them in court...being sued.

[Elvish, BSN, DNP, RN, NP]

When my cousin was pregnant with her 2nd, she called me very upset. Her doctor had done an ultrasound and recommended a c/section for her because they suspected macrosomia. This makes me really mad when docs do this. She was not gestational diabetic, her pressures were fine. There was nothing else wrong with her pregnancy other than they 'suspected' a large baby. I told her that I couldn't make the decision for her, but to remember 1) that women's bodies do know how to birth babies, and 2) 3rd trimester ultrasounds are notorious for being inaccurate. Her first had been over 8lbs and she had no trouble birthing him at all, and I asked her to remember that too. (Women in our family tend to grow them big - if it weighs anything under 9lbs, they ask you if that's the best you could do. My uncle was almost 12lb, NSVD, minor perineal tearing.)

Well, the ultrasound was right - he was a large baby. 9lb 15oz, to be exact. Birthed lady partslly. The same doctor who suggested the section also caught this baby, which I think served her right.

IMO, it is a mix of things: control issue, fear of litigation, fear of losing revenue if you don't give the patient what she wants, being sick of a particular patient calling the office, and sometimes it is honest-to-goodness (if misplaced) a feeling of having the patient's best interest at heart. I think all those things come together to increase the elective c/s rate. It's probably not every one of these things for every doctor, but I think this covers most of the bases for most doctors. Most OBs I know are decent people and aren't out to intentionally harm anyone, but they only know what they've seen. It's amazing to think that there are doctors out there who've never been party to a low- or no-intervention birth.

After recovering people from both NSVDs and from sections, give me ten NSVDs any day of the week before slicing my belly open once.

[KareBear0609]

How about just the simple fact of being induced? It drives me nuts when women are induced just because they are going on a vacation or their husband can only take off work such and such week. Or they are told their baby is going to be 9+ lbs, they deliver 3 weeks early, and it comes out 7lbs.

[caregiver1977]

My OB offered a c-section with my second (my first was induced for pre enclampsia, so was my second in the end). He actually looked shocked when I told him no. SMH.

[shart]

It is why I won't go near l&d when I finish my nursing program. I'm tired of doctors practicing "cover their ass" medicine. They pressure or encourage intervention births so they can have control over the situation. They don't care what's best for moms or babies, but what's best for them. Malpratice insurance doesn't help either when they refuse to cover doctors who deliver VBACs and such. Hospitals aren't helping as they ban VBAC instead of encourage VBAC. The US system is all messed up.

When I was pregnant with my twins I had to search for a doctor who was willing to even try a lady partsl birth. The real kicker is I had a proven pelvis! I had another son prior to them and with zero complications. Yet I was basically told "C-section!" for no reason. I finally found a high risk OB who would be okay with a natural delivery. I still have:heartbeat for that man. Not only did he not even suggest an epidural when I came into l&d in labor, but he stayed with me in my room through-out most of my labor. He only left once for a small coffee break. I delivered two healthy babies who were both almost 6lbs. No complications. No epidural. No NICU. I have no doubt if it had been any other doctor I'd have had a c-section. I'm not having anymore kids and I'm glad because I'm getting more and more scared of the system. In the US right now our c-section rate is really high and only keeps going up. Studies have proven that it's not because of more complicated deliveries. A good portion of them are SIMPLY repeat c-sections. Why we don't encourage VBAC and get more hospitals doing them I'll never know especially since more and more studies are showing that VBACs are safe. The risk of rupture is only a fraction of a percentage higher than a first time mom.

[klone, MSN, RN]

For those of you who are horrified at the idea of working in OB and all the interventionist medicine that takes place, let me assure you that not all places are like that.

I currently work at a teaching hospital that has the lowest C/S rate in Colorado. The residents are taught EVIDENCE BASED MEDICINE, not "CYA Medicine". I took care of a patient that had a crappy strip all night. Decels into the 60s with every single contraction. For several hours. I had reached my personal threshold by around 1am and wanted to take her back for a section at that time (and I'm very crunchy granola natural birthing, dislike interventions kind of person). The midwife felt the same way. It was the chief resident who talked US down, pointed out that the baby had good variability between decels and was clearly not acidotic, and it was okay to sit on the strip a little longer. We ended up sitting on the strip until 6am, when the woman delivered lady partslly with a perfectly healthy baby. If it had been up to the midwife and me, she would have been sectioned at 1am. But because of the cool head of the resident, this woman got the lady partsl birth she wanted.

Our facility allows waterbirths, it allows mothers to not have an IV if she so chooses (assuming she's not being induced), it does not offer "social inductions" and inductions for post-dates don't occur until after 41 weeks (I've taken care of some almost 43-weekers). We do VBACs as well as lady partsl breech deliveries.

So even though the "CYA" method of practicing medicine is prevalent, it's definitely not everywhere. If you have a desire to go into OB nursing, don't let the horror stories scare you away. It may be harder to find, but true evidence based practice of medicine does exist, even in OB.

[JRP1120, RN]

I totally agree with the person that recommended "The Business of Being Born". I watched it on Netflix also. It was very interesting.

I'll be watching it tonight!

[nursetiffany.]

scary. as a nurse and pregnant with number two...i go as natural as possible. our bodies r made to handle birth...why not let them unless medically necessary? hell, i think taking pain meds during labor is dumb. bit too each their own.