Elective Primary C/S

Elvish, BSN, DNP, RN, NP · 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.

It's not a matter of whether I agree w/ their decision....it's a matter of supporting evidence-based practice. It does not hurt me physically one way or the other if a mom has a c/s or a svd, but current research indicates that it is not a benign procedure, for mom or for baby.

Sheila C · Feb 4, 2009

I haven't seen very many here in Oklahoma, or in Kansas where I worked, but I did travel nursing in California and I had several....Sheila

Sheila C · Feb 4, 2009

In my previous post I did not add that I had a 4th degree laceration with my first, so in light of that, I do feel that I should have had a c/s. If it is advised due to a medical condition, gestational size etc. I feel that a woman should be able to request, rather that than a should dystocia or bad outcome for any Mom or baby. Sheila C.

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

Even gestational size opens up a big can of worms - you get the docs that section for 'macrosomia' and deliver a 4lb13oz baby (true story). I put very very little faith in 3rd trimester u/s, as they are wrong about as often as they're right. I don't think we (as the medical field, not any one individual here) give women's bodies enough credit when it comes to birthing big babies. I hate shoulder dystocia as much as anyone, but relative to the number of big babies I see delivered lady partslly, it's a very very small number. Even smaller when mom can deliver upright vs. on her back or has enough feeling in her lower extremities to pull a Gaskin. JMHO, as always.

And I totally don't buy the small mom = inability to deliver big baby theory. I have seen 5ft and under deliver 9lb+ babies too often.

Sorry for the soapbox. I just really think we intervene too much in birth sometimes.

mamafeliz · Feb 5, 2009

Thanks, everyone, for your replies. A couple of posts stated that elective primaries are becoming more common in their facilities, but maybe the perception is overblown that they are MUCH more common. There is certainly a consensus that the trend is a bad one, and I am in full agreement.

Any ideas of how we as OB nurses can impact this trend? If someone is scheduled ahead of time and arrives on the floor ready for their operative birth, it is too late. Possibly addressing the increased risks in child birth ed? One problem I see is that hospitals actually benefit from increased c/s rate as receive higher payments. It seems to me to be a public health issue. Who do we address and how, as the public toll seems high?

Elvish, BSN, DNP, RN, NP · Feb 5, 2009

I hate to play blame-the-doctor, but the fact of the matter is that if doctors did not offer it, women would not have a choice. Some doctors feel that it should be a valid choice and place it in the category of patient autonomy. IMHO, that is where patient education has to start - in early pregnancy, or even preconception. I also think that if more midwives existed and were allowed to practice true midwifery, then we would see the overall c/s rate drop, and with that, the primary elective c/s rate.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1479446

mamafeliz · Feb 5, 2009

Increased midwifery model would absolutely help. You would think insurance companies would be motivated to decrease c/s rates and frown upon elective c/s. Certainly any state funded patients would not have this option..

lisamct · Feb 5, 2009

Being in the UK we dont have the financial issues you guys in the US have with insurance etc but one of the big things recently where I am that has reduced the amount of elective c/s in general has been the change in timing of offering the procedure ante natally.

Although as I said before we have very few elective primary c/s, when these happen this is usually always due to a suggested medical complication e.g placenta placement issues, maternal health issues, breech (although un-necessary c/s for breech is another of my soap box issues that I wont go on a rant about here!)

Plans for method of delivery arent put into place here until women at 37/40 so elective c/s arent even discussed until this point. We have greatly increased the onus on the medics who consult with these women to discuss both the pro's and cons of the procedure in detail to ensure full informed consent is gained (I know of several women who have been put off after this as they had no idea that the recovery time may be so long or that they would be required to have anticoagulant jabs for 5 days afterwards and have instead gone on to have lovely physiological births)

We also ensure women are aware of the alternatives e.g ECV or Moxibustion for breech babies rather than going straight to c/s as well as the true statistics of repeat perineal trauma etc.

Of course some women still go on to choose the c/s route or feel the medical concerns warrant it and so be it, they're often taking the safest route for them and their babies but at least we know they're doing it with all the information on board.

Elvish, BSN, DNP, RN, NP · Feb 5, 2009

We also ensure women are aware of the alternatives e.g ECV or Moxibustion for breech babies rather than going straight to c/s as well as the true statistics of repeat perineal trauma etc.

I am not sure that our docs even teach moxibustion. They will on occasion do a version. A friend of mine had a baby that was determined to be breech @ 35 weeks. She did the exercises and moxibustion with a CPM, and a couple weeks later, baby flipped. Nice NSVD at home. :yeah:

lisamct · Feb 5, 2009

I am not sure that our docs even teach moxibustion. They will on occasion do a version. A friend of mine had a baby that was determined to be breech @ 35 weeks. She did the exercises and moxibustion with a CPM, and a couple weeks later, baby flipped. Nice NSVD at home.

Fantastic to hear, good for her!

I think statistics still show that Moxibustion is just as effective, if not more so, at turning breech babies than ECV as well as being less interventional and therefore safer for all involved.

Our docs dont personally provide Moxibustion treatment but will offer it as an option and refer onto either one of our trained midwives or a private practitioner if thats preferred/easier for the women.

Surgerygirl · Feb 5, 2009

The overall c/s rate at my hosp is between 35-40% a month. It is crazy. Last night I had a scheduled pc/s come in for admission and when I asked her why we were sectioning her (G1/P0) she said that the Ob told her that her baby "might" to too big and gave her a choice of pcs vs trial of labor...... then she requested general anesthesia!!! ...... and the crazy part was anesthesia went along with it........

TRINI_RN · Feb 7, 2009

I haven't seen one since I've been on my unit. I asked a nurse who's been there for almost 5 years and she said she can only remember one. I personally oppose elective primary sections, it is after all still major abdominal surgery.