Elective Primary C/S

Specialties Ob/Gyn

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On our unit, Primary Elective C/S have become pretty popular, for this main reason, "I don't want to go through the pain of labor". Now, with that said some of these young ladies insist on also having a general anesthetic because "I don't want a needle poking me in my back". I find myself getting fustrated with these pt's, I don't like to feel that way towards them. A small percentage of these young ladies don't even know why the Doc has even scheduled them for a primary c/s, and then the advocate comes out in me and when the patient asks the doctor for a trial labor, the doc talks them out of it. It really frustrates the hell out me. What do other's feel about this new trend? I really need to see if this is occurring more frequently nationwide or if this is a local issue. I understand if there is true CPD, breech, or maternal complication that would require a primary, but too many times these babies are vertex and average birth weight that are delivered. It's one thing when a pt has gone through labor and is FTP, failure to descent, or fetal distress that send them packing into an OR, but this Primary elective issue has just grated my nerves. My other co-workers are frustrated as well and the response from my peers is "we just have to accommadate the docs order". Please share some insight regarding this issue.

Specializes in L&D,Wound Care, SNC.
OK, I'm sorry, not meaning to flame you, but when it comes to inducing general anesthesia on an obstetrics patient, it is obvious that you need some education. This is simply and strictly for your edification:

General anesthesia is risky business for c-section for several reasons. Did you know that the highest incidence of failed airway happens in the pregnant patient? Did you also know that the pregnant patient is always a "full stomach",putting them at serious risk for aspiration upon general anesthesia induction? And because of the respiratory system changes that occur with pregnancy (i.e. decreased FRC and increased O2 consumption), the parturient patient desats quickly upon anesthesia induction. Furthermore, because inhalation anesthetics promote uterine relaxation, they contribute to maternal hemorrhage. Not only do these factors add up to a significant life risk for the mother, they combine to make general anesthesia risky for the baby. Barring contraindications to neuraxial anesthesia, only emergent C-sec patients should be going to sleep.

It might also interest you to know that general anesthesia for c-sections carries one of the highest rates of recall under anesthesia (right up there with traumas and heart surgery).

Anesthesia providers don't "pressure" moms to have a "needle stuck in their back" to make our own lives easier.

:yeahthat:

I don't mean this disrepectfully but...You think general is going to take your pain away??? Think again, the second you wake up you will be hurting like you have never hurt in your life. (at least that is what my patients tell me) and it takes a LONG time to get it under control. It has been my experience (albeit breif) that my patients, for the most part receive adequate pain control with the preservative free morphine in the spinal/epidural, plus the remainder that is given IV.

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Yes, they are.

Why has it become acceptable? That's the question... my quess would be that it demonstrates the power of the MD's &/or fear of litigation. We'll see if the power of insurance companies comes into play at all when they get sick of paying for more and more c/s. ??? There is also obviously a lot of misinformation or partial information getting out on vag vs. cesarean birth; some people do not realize that risks are much higher with c/s.

I always thought the reason they started allowing these types of sections was because they made "pain" the 5th vital sign. Pts can sue doctors and hospitals because they were in too much pain during their hospital stay, and this applies to OB pts as well. I've heard stories of lawsuits because of pain in the OB setting, including laboring pts. I think its ridiculous, but in todays sue-happy world, pts can say they want the section because they don't want the pain of childbirth. I just don't understand why they think the pain is less w/ a section.........We all know its not.

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Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.
:yeahthat:

I don't mean this disrepectfully but...You think general is going to take your pain away??? Think again, the second you wake up you will be hurting like you have never hurt in your life. (at least that is what my patients tell me) and it takes a LONG time to get it under control. It has been my experience (albeit breif) that my patients, for the most part receive adequate pain control with the preservative free morphine in the spinal/epidural, plus the remainder that is given IV.

Having had two sections with epidurals, and an open abdominal surgery with general, I'd take the epidural any day of the week.

When I had my second, scheduled section, the anesthesiologist was in the process of putting my epidural in when people started running around like mad. I got repeated apologies because my section was delayed when my doc had to do an emergency section on another mom. (Fetal heart rate dropped, couldn't get it back up, it turned out to be an abruption). Anyway, this other mom was in the room across the hall from me postpartum. She'd had the emergency section under general, I'd had the scheduled one with an epidural. I firmly believe she was in way more pain than I was.

Duramorph is a wonderful, wonderful thing.

And, for the record, I was not upset at being bumped back. I kept telling them to take care of that baby, mine was fine.

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Specializes in CRNA, Finally retired.
Ah, another reason why I'll be happy to retire in a couple of years. Perhaps we should just install zippers at the first prenatal visit and get it over with. If the patient has said she doesn't want the pain of labor then that, unfortunately, is being used as a reason. Quicker, easier (for the doc anyway) and more $$ in the till. I'm so uneasy about the trend also.

It sounds like there are two issues here: one is patients requesting and getting an elective primary c/s and the other is being scheduled for one, but requesting a trial of labor. Questionnable practices in both cases, IMHO.

I have to agree with the spinal/epidural thing. There's NO WAY IN, well, no way, I'd ever agree to having either. It just freaks me out and in 30 years of labor nursing I have seen few, very few indeed, c/sections which were done so slowly as to compromise the infant. They are fast, no matter what, so why not let the patient truly decide, instead of pressure them into having that needle stuck in their back. In more cases than I can count, the spinal or epidural wasn't adequate, the patient had pain issues during the surgery, only to be told it was "pressure." Yeah, right. Not me, baby. Put me to sleep, play your music, do your job and I'll b e oh-so-happy when I wake to have it all done with.[/Q

Putting a patient to sleep for a c-section without a compelling reason (i.e. bleeding issues, serious fetal distress) is shoddy practice - period. So is giving them elective c-section. Has the caliber of physician who chooses this type of practice gotten that low? We had a young patient recently who came in and requested an epidural immediately so I guess the midwife figured that they might as well start a pit drip. Fortunately, the patient's mother showed up and she was a midwife and said no go to either and gave the midwife a tongue lashing for even considering a pit drip on someone who just walked in the door. Daughter delivered without either. A happy and ethical ending for all.

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Specializes in L & D; Postpartum.

Thank you for the information regarding epidurals and generals...I've been a labor nurse for 30 years and already know all of that. My own personal bias against epidurals is NEVER communicated to patients. If they ask me if I would have one, I say something about it being a personal choice and every situation is different.

I WOULD NOT agree to have one. Period. For any reason. The idea of that needle going into my back is one of the few things that can put me over the edge. One of my sisters is a CRNA so when I have questions I've never had far to go.

And some anesthesia providers DO pressure patients to get an epidural. As do docs. Not all, but some.

I didn't take your comments as flames, but I guess you took mine as uninformed comments, rather than personal views. Sorry for that.

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Specializes in Looking for a career in NICU.

Britney not only had an elective c-section, with both children she went in 6 weeks before her due date to avoid stretch marks...why is the American Medical Association not pulling licenses for this sort of thing?

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Specializes in Maternal - Child Health.

Because they don't issue licenses, or have any authority to discipline them.

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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.
Yes, they are.

Why has it become acceptable? That's the question... my quess would be that it demonstrates the power of the MD's &/or fear of litigation. We'll see if the power of insurance companies comes into play at all when they get sick of paying for more and more c/s. ??? There is also obviously a lot of misinformation or partial information getting out on vag vs. cesarean birth; some people do not realize that risks are much higher with c/s.

One OB that used to be at our hospital would OK to do a section just so he's not "sitting around forever waiting for her to push."

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Specializes in Med/Surg.

Wow, I'm just amazed that there are doctors agreeing to this.

And if the reason is to "avoid the pain of labor", well, I've got news for those girls. Granted, I never experienced labor, but the section was not a walk in the park.

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I think it's a very tough call. I think scheduled c-sections for vanity reasons (like 6 weeks early so someone won't have stretch marks) they should be illegal. There is a reason why nature has set human gestation at 9 months. I feel the same about induced labor when there is no medical reason, so someone can have the baby on a Friday, or some other silliness.

You've got to be kidding me. Why not take the soon to be mom for a stroll down to the NICU and see what pre-term babies look like and the problems that can arise from an early delivery? A dr. performing a c-section early for a reason such as vanity issues should be sued for endangering a child.

Hey, when you're pushing a watermelon through a hole the size of a straw it's gonna hurt.

I actually did a research paper on the increase in c-sections in the last ten years. Got a 99% on it. I'll see if I still have it saved because it has some very good statistics on c-sections and complications.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Read an article stating nationwide c/section rate was 30% in 2005. This is a scary trend to me.

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Specializes in Looking for a career in NICU.
You've got to be kidding me. Why not take the soon to be mom for a stroll down to the NICU and see what pre-term babies look like and the problems that can arise from an early delivery? A dr. performing a c-section early for a reason such as vanity issues should be sued for endangering a child.

Hey, when you're pushing a watermelon through a hole the size of a straw it's gonna hurt.

I actually did a research paper on the increase in c-sections in the last ten years. Got a 99% on it. I'll see if I still have it saved because it has some very good statistics on c-sections and complications.

Amen sister!

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