Elective Cesareans/On Demand

HeartsOpenWide, RN · Jul 15, 2005

The case of a breech baby puts her in the category of "medical necessity" anyhow!

I find this statement so sad. So if a woman wanted to deliver her baby breech she "wouldn't be allowed to" ? I think I would fight tooth and nail if I had a breech baby that would not turn to lady partslly deliver my breech baby. I've seen wounderful breech babies come out, and at home births.

I relise what a fight it can be though. My MIL had an "oops" pregnancy almost three years ago (well the delivery was almost three years ago) NO ONE in this area would deliver her twins without a section. We had to wait until an OB from out of the area that comes up once a month to come. She then, agains her normal standards, relucted to induction so she could have the babys lady partslly while this OB was still in the area. Baby A was head down, but baby B was transvers (this is why no one wanted to deliver her) as soon as twin A was out twin B had enough room and in a matter of 5 mins she had turned. Of course we were all happy. MIL said she almost wished she could have defeted the challenge of a breech, being that this OB would have allowed at least a trial.

CrunchRN, ADN, RN · Jul 15, 2005

Explain all risks, all benefits, all options, and then it should be the woman's choice as long as it does not increase risk for the baby. Her body, her baby, her choice. I think women who make choices based on their fears and convenience are being selfish, but hey, some people are selfish. It is not my job to impose my morality on them. That said - I wish more people would realize that they would be better off without elective inductions and surgical birth when not required by babies condition. I do believe that a woman has the right to make her own choices - no matter how stupid I might think they are!:chuckle We all have our own history and reality influincing our lives.

RNnL&D · Jul 15, 2005

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).

Ooooh, I get it. Yeah, I guess when I worked in a small community hosp (35 beds) we did call the ER doc for back up when there wasn't an OB in house.

We do VBAC's where I am now. But we do have OB in house and 24 hr anesthesia. And as far as I know, we have only had one elective CS. She was one of the L&D nurse's sister. She had fibroids and panic disorder. Mom and sis had CS, so the thought of labor, then an emergent CS caused her to have a panic attack.

SmilingBluEyes · Jul 15, 2005

I find this statement so sad. So if a woman wanted to deliver her baby breech she "wouldn't be allowed to" ? I think I would fight tooth and nail if I had a breech baby that would not turn to lady partslly deliver my breech baby. I've seen wounderful breech babies come out, and at home births.
I relise what a fight it can be though. My MIL had an "oops" pregnancy almost three years ago (well the delivery was almost three years ago) NO ONE in this area would deliver her twins without a section. We had to wait until an OB from out of the area that comes up once a month to come. She then, agains her normal standards, relucted to induction so she could have the babys lady partslly while this OB was still in the area. Baby A was head down, but baby B was transvers (this is why no one wanted to deliver her) as soon as twin A was out twin B had enough room and in a matter of 5 mins she had turned. Of course we were all happy. MIL said she almost wished she could have defeted the challenge of a breech, being that this OB would have allowed at least a trial.

I have seen OB's deliver breech babies, but the chances of dystocia DO rise considerably. You see, when you realize the head and shoulders are the biggest part of the baby --- YET TO COME after the feet and body---- and you have MINUTES to get him/her out before brain damage ensues----you see why so many OB's elect not to do this anymore.

I have seen horrendous dystocias in head/vertex deliveries, enough to make me think and rethink my choice to be an OB nurse. ......one bad dystocia is all it takes to give you serious nightmares....

Now, I have met and worked with quite a few doctors/OBs quite skilled and comfortable for years, with breech deliveries. These guys had probably done 100s of them in their careers. Things have changed. Women/families back then did not sue if a family member fainted in a delivery room, hitting their head or something. (the example in the other thread). People did not sure for every accident occurring in the days of these OBs doing breech delieveries comfortably---for things beyond the control of both patient and HCP. Those days are gone and unfortunately, finding HCPs comfortable with breech delivery are becoming increasingly rare. People KNOW doctors, and in particular, hospitals have very deep pockets!

Personally, I remember a horrible breech delivery going bad some years back----baby had resulting CP and of course family sued (lifetime care is expensive). Unfortunately, catastophic incidences and insurances guide VERY strongly the practices of OB's today------so yes, in many cases, Breech presentation IS an indication for csection delivery, particularly if version has been tried and failed. Am I saying I think all breeches should be delivered by csection? Not necessarily. I am saying, after informed consent, and all, even if something goes wrong, who is going to be held liable? Despite such consent, not the parents, but the health care providers. Again, another case of a sue-happy world controlling/dictating obstetric and midwifery practices. I don't like it but this is the way it is.

What families and midwives elect to do at home deliveries is another situation altogether, as you know. It will be tough in this day and age to find a hospital allowing planned breech delivery. Heck, it's hard to find one allowing VBAC now. Sad you say-----or MAD? So am I. Thank the lawyers, insurance companies and families who would sue a the drop of a hat! :angryfire

FrumDoula · Jul 15, 2005

Now, I have met and worked with quite a few doctors/OBs quite skilled and comfortable for years, with breech deliveries. These guys had probably done 100s of them in their careers. Things have changed.

If homebirth with a skilled midwife was not an option for me, and I had a breech baby and a young doctor, I think I would possibly choose a cesarean delivery. Why? Because while the older docs were taught these skills and utilized them, the younger docs are NOT being taught it in the same way, and I think that makes for a much riskier breech birth. Of course, I would do everything I could to find a doc who would catch a breech, but reality being what it is, it could be much harder.

It really bugs me about how epidurals, induction, c-sec and other interventions get defended in the word of "choice", "alternative" and "non-judgement", but when a woman desires to have a breech, a VBAC or a natural birth, she often faces an uphill battle from her care providers, her nurses, her family and our society. Where is the choice based on knowledge of alternatives there? "Choice" is becoming an ever-increasing joke on many L&D floors, and it breaks my heart.

I continue to recognize that this frustrates and burns out many nurses as well, and to be fair, there are docs who are simply disgusted by the path ACOG and some of their fellow physicians are taking to encourage elective c-section and discourage VBAC. I feel for them, especially when their options are also cut off by insurance companies.

Alison

And thanks for the well-wishes on the birth!

SmilingBluEyes · Jul 15, 2005

It's not easy for any of us. Like I said, you have the insurance industry, lawyers and a lottery-playing mentality out there to thank. Hospitals can't afford this anymore, nor can doctors and nurses.

SmilingBluEyes · Jul 15, 2005

Man, I'm new- our names are so similar. Can I change mine so we don't get confused?

you will have to ask the mods this one. I have no idea if you can. If you do it may decrease confusion-----this has been my nickname for 3 years now.

Oh and welcome to allnurses, judy!!!

BETSRN · Jul 15, 2005

I find this statement so sad. So if a woman wanted to deliver her baby breech she "wouldn't be allowed to" ? I think I would fight tooth and nail if I had a breech baby that would not turn to lady partslly deliver my breech baby. I've seen wounderful breech babies come out, and at home births.
I relise what a fight it can be though. My MIL had an "oops" pregnancy almost three years ago (well the delivery was almost three years ago) NO ONE in this area would deliver her twins without a section. We had to wait until an OB from out of the area that comes up once a month to come. She then, agains her normal standards, relucted to induction so she could have the babys lady partslly while this OB was still in the area. Baby A was head down, but baby B was transvers (this is why no one wanted to deliver her) as soon as twin A was out twin B had enough room and in a matter of 5 mins she had turned. Of course we were all happy. MIL said she almost wished she could have defeted the challenge of a breech, being that this OB would have allowed at least a trial.

Breech lady partsl births carry a higher risk of injury to the baby.

SmilingBluEyes · Jul 15, 2005

Breech lady partsl births carry a higher risk of injury to the baby.

indeed they do, as a result of dystocia. I agree---I did discuss this on the previous page for anyone who is interested in seeing that. :)

Pixie Dust · Jul 16, 2005

The only time I have ever seen a request granted for an elective c/s was for a prime who's reasoning was that her mother had bladder problems after giving birth. I was absolutely shocked that the insurance company would pay for that. After reading this forum I'm getting the impression it's not that uncommon. As for the elective induction rise I'm surprised insurance companies (and those of us who pay for insurance) are paying for a higher cost to delivery considering the cost that is involved in putting a woman into labor. I must admit though with the way staffing is being cut at my hospital it is to the nurses benefit to have labor by appoinment. At least we get staffed for that. The new trends are a shame.

ftr_bb_catchr · Jul 16, 2005

Maybe its time we did put change on our agendas. I find OBGYN's to be pretty much under the thumbs of the patients. 45 year primips are allowed to labor "for the experience" and the c-section goes at 10 p.m. so we can get the patient out of the OR before we have to use the night call team. No one can have a baby anymore without a garden hose in her back. Giving birth used to be such a growth experience for women - it definitely helped your self-esteem that you were able to experience some short-term pain (nothing like the pain, however, that a snotty teenager will give you later).
Kowtowing to so many ridiculous, expensive patient demands is just a form of whoring. Lets give labor and delivery back where it belongs - to the midwives.

Your last sentence alone makes me want to just KISS YOU!!! Lord bless you for saying what I would have.

ftr_bb_catchr · Jul 16, 2005

AND P.S. Why on earth, barring some medical emergency or physical problem, which I completely sympathize with by the way, would someone want to have surgery when you can push that baby out yourself? I for one thought birth was wonderful and would have been really sad had I not been able to be an active, pushing participant.