Elective Cesareans/On Demand

SmilingBluEyes · Jul 17, 2005

Just an update.....my sister gave birth to a 10 lb 8oz baby boy yesterday via CS.....baby is in the NICU because his breathing has been very fast and shallow, mom began to hemmorage last night but thankfully is okay now (after Hemabate, Cytotec and Methergan??? haven't heard of that one) She's very anxious to see her baby, but they still want to keep him. He had meconium staining, but his CXR was clear yesterday.
Okay, I'm finished hijacking the thread...continue on!

CONGRATULATIONS!!!! I am glad things look like they will turn out.

dwetherelt · Jul 21, 2005

The national c/s rate is close to 30%, but not 50% (yet). Section on demand is being touted as a woman's "right" ~ the last couple conferences I've been to have essentially said if a prime (or anyone else) requests a section and the OB refuses, and ANYTHING goes wrong at delivery you're dead in the water in the courtroom.

I think we'll see a continuing rise in the section rate (have at every place I've been in the last five years) until, as will inevitably will happen, we begin to see maternal mortality ~ which will happen. The risks of surgery are RARE, but real . . . increase the number of sections and the chance of that rare complication happening also increases.

ravenwindrn · Jul 21, 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.

Yes!!!! I couldn't have said it better myself. :)

mari31666 · Jul 23, 2005

hi

i think c/s on demand is used way too much for convenience. i had a pt who had been in triage for 4 hrs demanding to be section. she came the day before to usa and next day to our facility. no insurance no understanding of the process in our facility and demanding that we "hurry up, i'm tired of being pregnant". she stated she had c/s with 3 other babies so we went with refused vbac. from foley to epidural she complained and refused every step of the way. wanted the section under general and no foley and no shave and no prep because they don't do that in her country.

and on conveiencing attendings HA we have one that sends 5 or 6 pts at a time on his late night office hours all inductions and sections. they come in about 1030 pm and he doesnt show up til way after 8 am after a good nights sleep. if they contract and progress quickly we brethine them to keep them from delivering. very ethical huh? not to mention some attendings who tell the residents to put pts on their sides and breathe when they are fd until they arrive at the hospital. sometimes 2 or 3 hrs later. wish the state could see that in action

mari31666 · Jul 24, 2005

the worst c/s on demand i've seen was a 17 yr old multip who didn't feel fetal movement for a week. she was 40 wks breech, no fhr at all on admission. she was put in the demise room, induced with cytotec and counseled by a loving rn thats been there 30 + yrs who supported her every which way. when i got the pt i mothered her as well especially when she told me she hadnt spoken with her family or mother in 5 yrs. her mother in law came to hosp and told this frightened, traumatized young child that in her country she had a breech delivery and baby died during delivery and they had to remove body leaving head inside and removed head by c/s. the pt was hysterical after that and refused to deliver lady partslly and demanded a section. it was done after several attempts by wonderful mds and nurses to support and educate the pt. it was still not a pretty sight and the girl was in so much anguish and pain after that she had to get a psych workup. families and friends sometimes need to wait in the waiting area if they arent going to help support pts.

JAHJF · Jul 24, 2005

Haven't read whole thread, but working on it.

After having 1 lady partsl delivery and then an emergency c-section, I will never understand how someone would rather go through a c-section if it is possible to deliver lady partslly. And it sure isn't easier (don't know who started that rumor). :uhoh3:

lady partslly delivery I was up that night walking around taking care of my baby, felt great.

C-section, had horrible pain, couldn't get up by myself, hard to get to baby when crying, I felt bad (b/c had to have so much help) [very irrational for a c-section mom to be thinking, I know :) ]

Very glad I had my section b/c medically necessary but would never ask for another one.

macanes, BSN, MSN, DNP, CRNA · Jul 28, 2005

Howdy.

No, I thought the c/s rate was 20-25% or so.

I have heard of well-to-do women in Brazil, for example, demanding and getting c/s for social reasons and about a 70-90% rate in some South American countries (re: NPR ATC program about six months ago).

I suppose c/s on demand might be considered acceptable medical practice by ACOG (don't know/haven't looked), but they'll then be elective in terms of our OR staff time -- and at the back of the line at our military facility.

Nationally the c/s rate is about 50%. ACOG (assoc. of OB's) put out a statement last year which essentially said that c/s on demand was acceptable medical practice.

na_mbawazier · Jul 31, 2005

Nationally the c/s rate is about 50%. ACOG (assoc. of OB's) put out a statement last year which essentially said that c/s on demand was acceptable medical practice.

for the last 3 years i noticed that c/s on demands was acceptable medical practice and it became as routine and the reason for performing it is history of previous c/s ( even if the patient can deliver lady partsly and did not demand for it)

na_mbawazier · Jul 31, 2005

administration of iv medication is (not in emergency cases) who is suppose to administer it. Drs or nurses.

obtech2nurse · Jul 31, 2005

As an ob tech that scrubed for several years before I had a baby I knew I did not want a c/s. Turns out my first child was breech, I couldn't find a doctor who would give me a trial of labor. My c/s experiance was horrible!! (That is another sorry all together) Well, I had an opps and had another baby 11 months later. I am glad to say, I had a successful VBAC. :) I had to interview three doctors and fire two to get what I wanted. (Our hospital that I worked at and delivered is trying to stop doing all VBACs.) Well I do not understand how anyone would want to choose to have a c/s. The recovery is awful. You don't get to see your baby for at least two hours after he/she is born and you still have to function as a mother without time to heal and recoup from major surgery. I believe that pts should be educated from professionals and make their own desicisons about what is best for them, but I do think there should be reasonable limits to an elective c/s. It is much easier to get an elective primary c/s then an elective VBAC. There is something wrong with that equation.

allnurses Guide · Jul 31, 2005

Well, not all ceseareans are the same. I have had patients who almost hopped out of bed the day after and could have gone home on day 2. We keep them 3 days however. And I had cesearean with my 4th child and the only reason I didn't see him right away was it was an emergency due to fetal distress and he went to the NICU for a couple of hours. He roomed in with me after that, I nursed right away.

It was pretty amazing how important your abd muscles are though . . . . it is a bit hard to even clear your throat post-op since your muscles have been cut.

All in all I have to say my experience was good.

steph

DoulaKelly · Jul 31, 2005

It amazes me the support that is given to patients for elective c-sections. I am a birth and postpartum doula as well as a nursing student. There have been many occasions that I have observed physicians not only supporting, but encouraging elective sections. Did something change and I missed it? Since when are the risks of a c-section less than a lady partsl birth for a mother who is not having any complications? One of my clients was told by her physician that a c-section was far less risky than a lady partsl birth, because it is a controlled environment! What the heck is that all about?

I trust that our bodies were made to birth babies naturally. I do also realize the thanks to medical advancement there are babies with us that wouldn't have been without c-sections. I don't think that childbirth is Burger King and you can just "have it your way" whenever you don't feel like being pregnant anymore. I found this thread very enlightening.

While I see the trend of elective c-section and banning VBACs going in a scary direction, I am hopeful that childbirth will again become a more normal and less medical experience.

Kelly