Elective Primary C/S

tntrn, ASN, RN · Feb 4, 2009

I am adamently opposed to elective c/s. Period.

NewNurseyGirl2009 · Feb 4, 2009

I am adamently opposed to elective c/s. Period.

You cannot oppose something someone else does that doesn't hurt them or someone else. It's not detrimental for the baby and C/S can prevent the mother from having bladder damage later on. It's her decision not yours. I had an elective C/S after a 4th degree tear the first time. Not medically indicated but it was the right decision for me. I didn't want another 4th degree.

lisamct · Feb 4, 2009

You cannot oppose something someone else does that doesn't hurt them or someone else. It's not detrimental for the baby and C/S can prevent the mother from having bladder damage later on.

Im sorry but to say C/S is not detrimental to babies or mothers (which Im assuming your also suggesting) is pretty inaccurate.

C/S puts babies at risk of respiratory problems, diabetes, hypertension, adult mental health issues, injury from surgery itself, effects of anaesthetic, depletion of immune responses and amongst other things the risks from prematurity as often elective C/S's are carried out to suit the medics and the mother without much thought for the best time for baby itself.

As far as mothers are concerned C/S is major abdominal surgery and carries the same risks as all other surgeries of the same nature including issues with bleeding, infection, trauma/injury during surgery. There are alsoi studies that suggest more postnatal mental health issues in women post C/S than after lady partsl birth.

I have plenty of references to back this up if your interested.

To the original poster, we see very few primary elective C/S where I am although I fear it may be becoming more commonplace. It scares me that medics are happy to perform major abdominal surgery on request, often for simple reasons of convenience only, its pretty shocking really.

tntrn, ASN, RN · Feb 4, 2009

You cannot oppose something someone else does that doesn't hurt them or someone else. It's not detrimental for the baby and C/S can prevent the mother from having bladder damage later on. It's her decision not yours. I had an elective C/S after a 4th degree tear the first time. Not medically indicated but it was the right decision for me. I didn't want another 4th degree.

While I respect your opinion, I have to disagree. First of all, there's no guarantee you will have bladder damage, and no guarantee you would have had a 4th degree the next time around. That can be WHO your attending was and HOW the delivery was handled. I've seen women with prior 4th degrees deliver without even a skid mark the second or third time around...with bigger babies too.

I had a broken coccyx with my second child, and a 4th degree, but no way would I subject myself to an unnecessary surgery, not to mention the risk to a child.

With the huge increased cost of a c/s versus a lady partsl delivery, I believe it unfair to others whose insurance premiums have to be adjusted in the long run due to these kinds of decisions.

NewNurseyGirl2009 · Feb 4, 2009

18 months later after my 4th degree ripped open and required a second reconstructive surgery? It would rip open again, guarentted. My baby was 6lbs and 3 weeks early so I guarentee I would end up with either a 4th degree or a shoulder dystocia which would put my baby at risk. I would like to know those sources so I could look them up myself.

HazeKomp, BSN, RN · Feb 4, 2009

I had an elective C/S after a 4th degree tear the first time.

Many WOULD indeed consider a previous 4th degree laceration as a medical indication for a C/S!

babies tend to get bigger with subsequent deliveries. I have seen this listed as an indication several times!

Haze

L&D x 28 years

iteachob, MSN, RN · Feb 4, 2009

You cannot oppose something someone else does that doesn't hurt them or someone else. It's not detrimental for the baby and C/S can prevent the mother from having bladder damage later on. It's her decision not yours. I had an elective C/S after a 4th degree tear the first time. Not medically indicated but it was the right decision for me. I didn't want another 4th degree.

Oh, but it can be detrimental to both mother and baby.

Baby more at risk for respiratory problems such as transient tachypnea. Also, there is the problem of delivering a not quite mature baby (again, mostly respiratory problems ensue).

Mom is at a threefold increased risk of DVT over a lady partsl delivery....not to mention other complications.

I've had a 4th degree tear (10 lb firstborn) also. I'd still pick the lady partsl delivery any day....and did, for the 2nd one (9 lb., 3 oz) with very little tearing at all.

HazeKomp, BSN, RN · Feb 4, 2009

We hear word that the trend is on the upswing in other facilities. What is your experience with and opinion about this trend?

opinion: terrible trend! increased risk of hemorrhage, increased risk of previa or acreta w/ subsequent pregnancies, NOT as good for babies trying to transition from "fetus" to "baby" as normal labor & delivery, does NOT "preserve bladders" statistically per studies, denies the "naturalness" of delivery as the body is well equiped to handle.

trend: more and more and MORE every year! Yuck! :madface:

rationale: 1) easier for docs to come for scheduled cases rather than coordinating labors/ deliveries with their office work, surgeries, home life.

2) incorrect assumption by public that it will "keep them tighter down there" for sexual pleasures and to avoid bladder problems later in life.

3) "instant gratification" mentality of our citizenry: don't want to wait for labor to take place, want to pick a date for delivery and "get 'er done".

4) easier for administration to schedule L&D staffing for scheduled cases than for "what comes through the door", so administration is supportive of elective c/s; plus, more lucritive w/ better payment by insurance companies for hospital stay.

5) so many have so much lack of self confidence that they actually can labor & deliver well! So much fear of labor, even with modern meds, epidurals, breathing techniques, etc.

10 years ago, we saw almost no elective primary c/s...

5 years ago, maybe one or two a year...

1 year ago, several per month...

past 3 months, one or two a week. :eek:

I teach prenatal classes for our hospital. It shocks me when attendees state that at the first visit their doctor offered them a scheduled elective c/s as part of their care choices! I hardly know what to say to these clients!

Hugs

Haze

Elvish, BSN, DNP, RN, NP · Feb 4, 2009

I think it is a bad bad idea. When I'm in the nursery and they tell me they're bringing a c/s baby, I automatically hook up the pulse-ox machine and make sure I've got some O2 tubing near the wall. C/S babies just don't transition as well.

C/S is more expensive, as others have mentioned, and that's not including any possible complications, not even minor ones like n/v or itching that often happens afterward. Forget something big like an infection (seen that more times than I care to talk about), a PE (once or twice), or peripartum cardiomyopathy. The cost goes way up. I give out far far more Percocets to c/s mamas than SVD mamas....increased cost. Percocet can slow a gut down...so pile on the stool softeners/laxatives/suppositories.

There have been plenty of studies done about the delay in bonding and/or breastfeeding r/t c/s delivery - mom is vomiting, bleeding, in pain, or groggy, or baby still has a belly full of amniotic fluid and is just not interested...any number of reasons.

I'm not saying all of these happen all the time...some are, very fortunately, rare. But it's not worth the risk to moms and babies to go doing it willy-nilly on an elective basis.

Pepperlady · Feb 4, 2009

I am not an OB nurse but this topic was one discussed with friends recently. What I found disturbing was someone wanting a elective C/S because she wanted to fit it in around a wedding she was to attend and did not want to risk missing it. Very very selfish IMHO.

Secondly I have heard of them being done to accomodate an OB/GYN schedule .... again very selfish idea.

NewNurseyGirl2009 · Feb 4, 2009

It was not medically indicated but rather advised. Still my decision and it was a good one at that. If it's that woman and her baby then it's her decision and as nurses your job is to advocate for your patient and their decisions, whether you agree with them or not.