Elective Primary C/S

Specialties Ob/Gyn

Published

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; Postpartum.

In the end, any anesthesia provider who does general anesthetic for no other reason than needles in the back give mom the willies are taking an enormous risk.

So, please, then tell us how you cope with the emotional and potentially very bad psychiatic needs of one who "has the willies" as you have glibly put it? I can assure, I don't have the willies about a needle in my back. It scares the c**p out of me.

And I think that any care-giver who ignores a patient's wishes or concerns and gives them no other choice is asking for a lawsuit. I totally understand the concerns from the physiological standpoint, but we should always be looking at the big picture.

Passgasser is not exaggerating. General anesthesia in a pregnant patient is risky, that is why its reserved for emergencies. Refusing to do a general because a patient is scared of needles is not cause for a lawsuit. Having an aspiration while inducing a patient who wants a general because she is afraid of needles is. The safest choice for mom and baby for an elective c-section is regional anesthesia. My own personal opinion is I would do whatever is safest for my baby, even if I'm scared of something. I would also want to be present and awake for the birth of my child.

Specializes in Anesthesia.

And I think that any care-giver who ignores a patient's wishes or concerns and gives them no other choice is asking for a lawsuit.

So you think that an anesthesia provider refusing to provide you with unsafe care is asking for a lawsuit? Umm, no.

It is standard of care that GETA is reserved for C-sec emergencies or those cases in which subarachnoid block or epidural would be contraindicated or has failed. Do you seriously think an anesthesia provider should be forced to provide you with whatever type of anesthetic you want, regardless of the risks? And you do have a choice. You always have a choice. It just might not be the choice you want. You can choose to have a neuraxial technique, or you can choose to have local anesthesia only for this major abdominal procedure, or you can choose not to have this ELECTIVE case done, at least not with the prudent anesthesia provider who is unwilling to risk your life by providing you with substandard care.

I just find it odd that you think a provider has a duty to provide you with whatever kind of care you demand, regardless of practice standards or risks involved. A provider does not have a duty to provide you with whatever you want just because you want it. They may not be able to force you to do anything against your will, however, they can refuse to provide unsafe care to you.

Specializes in L & D; Postpartum.
So you think that an anesthesia provider refusing to provide you with unsafe care is asking for a lawsuit? Umm, no.

It is standard of care that GETA is reserved for C-sec emergencies or those cases in which subarachnoid block or epidural would be contraindicated or has failed. Do you seriously think an anesthesia provider should be forced to provide you with whatever type of anesthetic you want, regardless of the risks? And you do have a choice. You can choose to have a neuraxial technique, or you can choose to have local anesthesia only for this major abdominal procedure, or you can choose not to have this ELECTIVE case done, at least not with the prudent anesthesia provider who is unwilling to risk your life by providing you with substandard care.

I just find it odd that you think a provider has a duty to provide you with whatever kind of care you demand, regardless of practice standards or risks involved.

Well, first of all, I would NEVER elect to have a c-section. So I guess right there, it would be emergent and you could feel better about puting me to sleep. And my two kids were born without anesthesia, also by choice. I do believe that if you have a mom that is clearly extremely anxious about an epidural, then other avenues should be explored. I can see a situation where a bad experience, out of fear, with an epidural could overshadow the happiness of the birth and MAYBE mess with the bonding.

It's just my opinion and my feelings, and I know, logically, they are probably unfounded. I also know that others do not have that fear, but for sure there are others out there. Please, try to see it as a personal thing, of mine. I've clearly stated it is MY fear.

Specializes in NICU.
I doubt your baby will weigh 10 lbs. Besides, I delivered my first baby, a 9Lb. daughter, without even needing so much as a stitch. It can be done. (The largest uncomplicated vag. baby I've taken care of was 12 pounds.)

If I go full-term, it very well might be that big! :) The baby was about 5 lb, 12 oz at 33-1/2 weeks per ultrasound. Somewhere around the 60th percentile, but it has been as large as 80th percentile in the past. Definitely cooking a big one in here! I'm very very very short though (under 5 feet) so I'm hoping that I'll just run out of room and go into labor before it gets much larger than 8 pounds. I'm already having a lot of pressure down there and started waddling this week. Baby didn't drop yet, as I still have shortness of breath and worsening reflux. It's just that I don't have much room, period!

If the baby is really really large, though, and not progressing very far down the canal during labor...I would definitely agree to a section. Reason being that in the NICU I've seen way too many asphyxiated babies who got stuck. A rare occurance, yes, but one that haunts you forever once you see it.

I don't care how any woman wants to deliver her baby- it's her right to choose and her wishes should be honored to the best of our ability.

It seems that we maintain that we are the patients advocate... unless the pt chooses something that we don't agree with personally. That's not right.

Specializes in Day Surgery/Infusion/ED.
So you think that an anesthesia provider refusing to provide you with unsafe care is asking for a lawsuit? Umm, no.

It is standard of care that GETA is reserved for C-sec emergencies or those cases in which subarachnoid block or epidural would be contraindicated or has failed. Do you seriously think an anesthesia provider should be forced to provide you with whatever type of anesthetic you want, regardless of the risks? And you do have a choice. You always have a choice. It just might not be the choice you want. You can choose to have a neuraxial technique, or you can choose to have local anesthesia only for this major abdominal procedure, or you can choose not to have this ELECTIVE case done, at least not with the prudent anesthesia provider who is unwilling to risk your life by providing you with substandard care.

I just find it odd that you think a provider has a duty to provide you with whatever kind of care you demand, regardless of practice standards or risks involved. A provider does not have a duty to provide you with whatever you want just because you want it. They may not be able to force you to do anything against your will, however, they can refuse to provide unsafe care to you.

Yep. It's not Burger King--you don't get to have it your way.

Specializes in Day Surgery/Infusion/ED.
I don't care how any woman wants to deliver her baby- it's her right to choose and her wishes should be honored to the best of our ability.

It seems that we maintain that we are the patients advocate... unless the pt chooses something that we don't agree with personally. That's not right.

It's precisely that advocacy that dictates that we speak up when a pt. is demanding something that is unsafe and not in his/her best interests. It's not about the personal preference of the provider.

If I go full-term, it very well might be that big! :) The baby was about 5 lb, 12 oz at 33-1/2 weeks per ultrasound. Somewhere around the 60th percentile, but it has been as large as 80th percentile in the past. Definitely cooking a big one in here! I'm very very very short though (under 5 feet) so I'm hoping that I'll just run out of room and go into labor before it gets much larger than 8 pounds. I'm already having a lot of pressure down there and started waddling this week. Baby didn't drop yet, as I still have shortness of breath and worsening reflux. It's just that I don't have much room, period!

If the baby is really really large, though, and not progressing very far down the canal during labor...I would definitely agree to a section. Reason being that in the NICU I've seen way too many asphyxiated babies who got stuck. A rare occurance, yes, but one that haunts you forever once you see it.

Please don't have more faith in ultrasound than you have in your own body! It's true that you may be having a big baby, but your body is building that baby and chances are everything will be okay. Those rare ocurrances are just that- rare.

I have always been a small person and delivered my 8'11'' first baby with no problems, a quick 30 min pushing. I have also seen in my short nursing school career several ladies who had sections for their "huge" by ultrasound 7 pound babies.

Good luck- sounds like between your doctor and your ultrasound tech you have a lot of stress coming your way.

Specializes in NICU.

I'm very very very short though (under 5 feet) so I'm hoping that I'll just run out of room and go into labor before it gets much larger than 8 pounds.

Hee hee. You sound JUST like me. I am 5 feet on a good day and about 100 lbs (not pg) My DD #1 had a growth spurt at 39 weeks gestation causing lots of lovely stretch marks (if she'd only come early.....)I went 3 days post "EDD" and my water broke. I too pushed for 30 min, after a nice moderately long labor, and out came my giant 8lb1oz baby@@. (her head was indeed huge though and I did some mighty fine tearing despite the support during crowning and slow stretching). My point is, babies don't run out of room, they just go OUT further!

What is it about short NICU nurses? We dominate our unit.

Specializes in NICU.
My point is, babies don't run out of room, they just go OUT further!

You're telling me. I'm 34-35 weeks but I look full-term, easily. By 32 weeks my belly had outgrown half of my maternity clothes. :uhoh21:

tntrn

First of all, rational or not, your fears are real to you. As an anesthesia provider, I recognize that fact, and have dealt with this very situation several times. I would not dismiss your fears, neither would I ignore them. You have the right to an anesthesia provider who would, at the very least, sit and discuss your fears with you to try to relieve you of some of the stress you are experiencing.

Though you would never elect to have a c-section, both of us know that there are times where a c-section, though neither emergent or urgent, is medically indicated. For example, if a woman has had a prior c-section, and is presented with all the facts regarding VBAC vs repeat c-section, it is perfectly valid for her, and medically sound for her OB doc, to decide not to take the risks associated with VBAC. I actually took care of such a woman, who because of the emergent nature of the situation with her first child, had to be put to sleep for that section. She presented for a repeat section, and she had many of the same fears you have regarding neuraxial anesthesia. In my interview with her, after taking her history, I told her we would be doing a spinal technique for her second section. She let her fears be known, and I had a long talk with her about the various kinds of anesthesia, and why general anesthesia for c-sections was reserved for only truly emergent cases. (This discussion lasted a good 30 minutes.) I answered all of her questions, and by the time we were done, she elected to have the section, with the spinal I recommended.

The point of this little story is to let you know that I never dismiss a patient's fears out of hand, but I also never allow a patient to steer a clearly dangerous course, when safer options are available. That's why I went to school for such a long period of time. I would far rather deal with a patient's psych issues, both in the pre-operative interview, and during the section, than to deal with a woman who has aspirated, or worse got into a can't ventilate, can't intubate situation because I allowed her to dictate anesthetic technique over my better judgement.

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