Elective Cesareans/On Demand

HeartsOpenWide, RN · Jul 15, 2005

Lets give labor and delivery back where it belongs - to the midwives.

:yeah:

HeartsOpenWide, RN · Jul 15, 2005

The International Cesarean Awareness Network has tracked more than 300 hospitals across the U.S. that have instituted policies seeking to ban lady partsl birth after cesarean (VBAC), misleading women to believe they must undergo cesarean surgery whether there is a medical need for it or not. Clinical research shows the risks of VBAC are small and that repeat cesarean surgery carries its own risks. In spite of this, many hospitals have attempted to ban VBAC to limit their exposure to liability. As a result, many women across the U.S. have been told they must choose unnecessary surgery or forgo hospital care altogether.

What can be done to stop this? BANNING VBAC?? Is arguing that a law should be passed that all woman should be allowed a trial of labor even worth it? Or possible? :angryfire

jkaee · Jul 15, 2005

2 decades ago, routine inductions for "maternal discomfort" and "social " reasons were all but unheard-of..

Deb, not to start a debate, but do you think that inducing labor or doing a section on a mom because of severe maternal discomfort is ever a good reason? My sister in due to have a CS tomorrow, she wanted to try VBAC after her twins birth, but the baby is breech. My question is, she is very large (she's only 5 ft and weighs close to 200 lbs now) and the baby is very large (according to US anyway). She is all stomach, just huge. Has bad arthritis in her hips from a childhood accident, barely able to walk. She has 3 other kids to care for. As a L&D professional, do you think in this or a similar scenario it would be benefical to get labor started? I know they type that you are referring to in your post....but do you think it's a good idea in case of legitimate maternal pain and stress?

(just for my own info and knowledge :) )

**RosesrReder, BSN, MSN, RN** · Jul 15, 2005

My neighbor has 4 children all by c-sections (as per her demand) she claims she'd rather be knocked out than to bear the childbirth pain. Also, she has a thing about "it overstretching" :rolleyes: :uhoh3: :uhoh21: :stone

She's just odd. I don't have children myself but I think so

sgent · Jul 15, 2005

National csection rate is 50%? I thought it was more like 26%. Where did you get that figure, out of curiosity? (not trying to start a debate, but I am really behind the times if these rates are that high). Thanks in advance for any info you can provide me.

Oops sorry... Looking at the 1993 data from ARHQ, there were 3,916,469 deliveries total with 1,170,408 being c/s, for a 30.0%. (http://www.arhq.gov)

I was thinking of c/s after c/s (VBAC) which was of which 230k patients recieved of 422k admited for it (54%) -- again 2003 ARHQ numbers.

Jolie, BSN · Jul 15, 2005

Deb, not to start a debate, but do you think that inducing labor or doing a section on a mom because of severe maternal discomfort is ever a good reason? My sister in due to have a CS tomorrow, she wanted to try VBAC after her twins birth, but the baby is breech. My question is, she is very large (she's only 5 ft and weighs close to 200 lbs now) and the baby is very large (according to US anyway). She is all stomach, just huge. Has bad arthritis in her hips from a childhood accident, barely able to walk. She has 3 other kids to care for. As a L&D professional, do you think in this or a similar scenario it would be benefical to get labor started? I know they type that you are referring to in your post....but do you think it's a good idea in case of legitimate maternal pain and stress?
(just for my own info and knowledge :) )

I'm not Deb, but I'd like to butt in here :) It does not sound as if your sister's C-section is being done for "maternal comfort". She has a breech baby, and has had a previous C-section, both legitimate reasons for scheduling a C-section at term. Her size and history of arthritis may make her recovery from surgery more challenging than recovering from a lady partsl birth, so in no way is she "taking the easy way out". I wish her well!

SmilingBluEyes · Jul 15, 2005

Deb, not to start a debate, but do you think that inducing labor or doing a section on a mom because of severe maternal discomfort is ever a good reason? My sister in due to have a CS tomorrow, she wanted to try VBAC after her twins birth, but the baby is breech. My question is, she is very large (she's only 5 ft and weighs close to 200 lbs now) and the baby is very large (according to US anyway). She is all stomach, just huge. Has bad arthritis in her hips from a childhood accident, barely able to walk. She has 3 other kids to care for. As a L&D professional, do you think in this or a similar scenario it would be benefical to get labor started? I know they type that you are referring to in your post....but do you think it's a good idea in case of legitimate maternal pain and stress?
(just for my own info and knowledge :) )

Well, to me, for strictly "maternal discomfort" no, it is NOT legitimate........

for other reasons related to it, maybe. I think all women are quite uncomfortable in that last 4-6 weeks of pregnancy----some discomforts are severe and need relief (badly pinched sciatic nerves come to mind right off the top)----and your example of arthritis may well be, too. The case of a breech baby puts her in the category of "medical necessity" anyhow!

That is not what I was talking about when I brought up unnecessary inductions; there are legitimate medical concerns that need to be considered, obviously......

However----- Being "tired of being pregnant" or citing "maternal discomfort" for the convenience of the obstetrician or the patient, are to me, NOT legitmate reasons to play around with Mother Nature by inducing labor.

I know about discomfort; I contracted from 31 weeks' on w/my daughter. I am only 5 feet 2 and had a baby who was 9lb. at 38 weeks (she was breech and kicking my bladder). I waited as long as I could before having my csection, for her benefit and safety. It certainly was NOT comfortable having her feet in my pelvis and bladder and her head in my ribs for 9 weeks, all while contracting every day, often frequently enough to send me to the hospital.

I know from the OB's standpoint, there are patients who literally "park it" at their offices, whining and begging "to get it over with" or come to the hospital time after time after time, for little to nothing going on, and leave angry we are not inducing them cause "it's time"....no medical considerations or complaints, they just are "ready" for it to be done

Heck----some as soon as 30 weeks have asked why can't they get it over with, they know "so and so's cousin's kid" who did GREAT in the NICU at 30 weeks....and on it goes.......I have had others want it over cause they have an out of town wedding or some other event they want to make. Yep it gets that silly!

From MY standpoint: Labor induction is NOT without some risks of its own----and serious liabilities for all personnel involved. I don't take labor-inducing agents such as pitocin or cytotec and their potential side effects lightly, EVER. Nor should our patients. Truly informed consent is one of my great concerns regarding labor induction and its indications. I think matters of convenience are being considered and weighted much more than they should be, these days. If a person wants convenience, she should not have kids or----from a medical standpoint, maybe should consider why he/she is practicing OB medicine ! :angryfire

SmilingBluEyes · Jul 15, 2005

I'm not Deb, but I'd like to butt in here :) It does not sound as if your sister's C-section is being done for "maternal comfort". She has a breech baby, and has had a previous C-section, both legitimate reasons for scheduling a C-section at term. Her size and history of arthritis may make her recovery from surgery more challenging than recovering from a lady partsl birth, so in no way is she "taking the easy way out". I wish her well!

thank you. You said it perfectly. This is an example of medical necessity, not a matter of convenience.

sgent · Jul 15, 2005

What can be done to stop this? BANNING VBAC?? Is arguing that a law should be passed that all woman should be allowed a trial of labor even worth it? Or possible? :angryfire

VBAC is one of highest threats for malpractice for OB/GYN's. Many malpratice carriers will not cover a VBAC -- period.

In addition, new JACHO requirements basically make a VBAC an impossiblity in any but Level I tramua centers -- you must have a GS (not in scheduled surgery), OB/GYN, and Anesthesiology on site for the entire duration of the delivery. Since hospitals aren't big about offering it anyway, and GS get pissed at being woke up and told to sit around for hours with nothing to do, the VBAC is generally going the way of the Dodo.

Even at our local hospital, which is a Level I, they have a separate women's hospital (with a couple of OR's), and JACHO won't let them do it since the surgeon is at the main building.

RNnL&D · Jul 15, 2005

VBAC is one of highest threats for malpractice for OB/GYN's. Many malpratice carriers will not cover a VBAC -- period.
In addition, new JACHO requirements basically make a VBAC an impossiblity in any but Level I tramua centers -- you must have a GS (not in scheduled surgery), OB/GYN, and Anesthesiology on site for the entire duration of the delivery.

What's this about a GS needing to be available? Since when is an OBGYN not a surgeon? Why would they require a GS?

sgent · Jul 15, 2005

What's this about a GS needing to be available? Since when is an OBGYN not a surgeon? Why would they require a GS?

Cause I'm in nana land with my brain :)... Glad I'm not working this week.

The standard is OB or Surgeon (in some rural hospitals the GS does the emergency c-sections, and there is no OB on staff. FP or CNM does normal deliveries).

The problem is that it requires immediate availability, which usually means decision to cut is 10 minutes, so both the OB and Anesthesia have to be ready to go the entire time the lady is in labor. This might not be a problem with a large OB group which rotates the hospital duty, and it isn't a problem in a level I trauma where anesthesia is readily available, but its a nightmare at smaller hospitals.

FrumDoula · Jul 15, 2005

The decision of so many hospitals to disallow VBAC is unsupported by medical evidence and bespeaks a truth about smaller and rural hospitals in general; that is, if it isn't "safe enough" to VBAC there, is it going to be safe enough to birth there at all, given that obstetric emergencies can happen to primips and multips with no history of cesarean?

I thought it was 30 minutes from "decision to incision" by ACOG standards, though I could be wrong. Anyone? SBE?

When I logged onto this board tonight, I saw the thread and inwardly groaned a little. As the local PITA representative for natural birth :) I thought I would hear a bunch of lame defenses for elective cesarean from some of the nurses, including my personal pet peeve, elective cesarean as a feminist and reproductive rights issue. :angryfire The argument that it's a "woman's right to choose" her c/s is remarkable only in its uncritical viewing of what the body politic has become. And I say that as a former women studies minor.

Imagine my suprise when I read so many fiery defenses of VBAC - no suprise at all that SmilingBlueEyes led the charge. :) :) I was just tickled to read all the responses and wish each and every one of those OB nurses could help make policy decisions about VBAC. It warmed the cockles of my heart, ladies.

And heaven knows I need it tonight. At 39 wks + 5 days pregnant, I am feeling a tad cranky anyhow. I mean, even the gas station lady said when I walked in for some ice, "You're still pregnant?!". And a complete stranger asked me my due date in Target tonight. :rolleyes: (My husband joked he was suprised that she didn't ask if I had any cervical dilation yet!) Although I am obviously not going to schedule an induction anytime too soon, and certainly not an elective cesarean, my time as Gestating Goddess is coming to a close, and I'm ready to begin my new role as Lactating 24-Hour Buffet.

So I can see why some ladies get impatient. But it's no reason to schedule major abdominal surgery for mere convenience, and ACOG should be ashamed of itself, bowing to the lawyers and their own conflicts of interest. Apparently, "do no harm" now applies more to the docs than to their patients.

For those who know Henci Goer and those who don't, here's a link to a variety of articles written by her on VBAC and other childbirth subjects. She is a medical researcher and childbirth advocate with some impressive books to her credit. They are noteworthy for their medical thoroughness, intelligence and passion.

http://hencigoer.com/articles/

You guys made my night. :)

Alison