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 CRNA, Finally retired.
Thank you for that comment, judy. After reading the rest of this thread I was wondering if anyone else felt this way.

Gee, patients should have the "right" to dictate medical care? We should do elective sections because the its the patient's choice? Do we allow children to choose whether or not to lose part of a leg to sarcoma because they don't want the surgery? Someone has to set a line whether a choice is reasonable or unreasonable. It is unreasonable to assume that I will put you to sleep for your elective c-section because I know that you may be frightened of pain, emotionally or intellectual immature or maybe plain crazy, but I am obligated to "DO NO HARM". It is a moral imperative - not a whim. That's why I believe that physicians who perform elective sections are about as helpful as a boil on a butt and shame on their professional associations for not policing them better. Its a lack of self-policing among themselves that is partly responsible for the messy system we have now. We had to wait until the 20th century for evidence based practice?

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My 2 cents... I loved the anticipation of every night wondering "will this be the night". I work straight nights so figured that would be my time to start labor. Yes it was for both. As far as pain, my first was an emergency c/s for complete and breech withing 1.5 hours of arriving. My second was a VBAC. Although I was much more uncomfortable after my lady partsl birth initially, the c/s was a much harder recovery over all. I was easily back to "normal" within a week. I still felt sore and wore out 3 wks out from my section. Thank goodness that was with my first because I would have had a 2 yr old at home with me second time around... Oh and not to mention I'm an NICU nurse who has seen more than her fair share of TTNB and PPHN from elective c/s. (does anyone else notice that they are doing them earlier as well?)

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I think you are right about the insurance companies but remember the physicians are entering diagnosis that would allow for the procedure, how is their diagnosis disputed?

I agree with you also about the ultrasound results. I was told by a MFM that my baby would be >9 lbs at birth, had me scared to death because my other three deliveries produced babies the were 7 lbs or under. It is very easy for all of these screening tests to provide data that would allow the physician to perform these c/s's because it is not an exact science, but the patient needs to be well informed of all that is possible without emphasizing the points that will scare the mother to have major surgery to deliver a baby.

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Specializes in ER, Family Practice, Free Clinics.
Yea... and uterine rupture (greater chance with each c-sec.) doesn't always happen during labor. It can happen at home... at the mall... you get the idea.

Gives me the shivers to think about that...

Of course, pregnant women freak me out in general, hats off to you OB & NICU nurses, I couldn't do it! I did rotations in high risk perinatal and NICU that gave me ulcers. I can't look at healthy, normal, pregnant women anymore without seeing "fetal demise at 8 mos", "hemmorrhage", "miscarriage", "twins, both brain damaged", "crying NICU mom" stamped across thier foreheads. It was really traumatizing for me. Give me a cancer patient any day of the week over a pregnant woman!

While I am still in school, I am thinking about doing this volunteer doula program. They train you, then you provide free services to help support moms though it that otherwise wouldn't have anyone. I think it would be great for the moms (don't worry, I can always hold it together in front of my patients) and might help me get over my irrational fear of pregnant women to see a few healthy uncomplicated births! Otherwise I may never come off birth control pills!

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Gee, patients should have the "right" to dictate medical care? We should do elective sections because the its the patient's choice? Do we allow children to choose whether or not to lose part of a leg to sarcoma because they don't want the surgery? Someone has to set a line whether a choice is reasonable or unreasonable. It is unreasonable to assume that I will put you to sleep for your elective c-section because I know that you may be frightened of pain, emotionally or intellectual immature or maybe plain crazy, but I am obligated to "DO NO HARM". It is a moral imperative - not a whim. That's why I believe that physicians who perform elective sections are about as helpful as a boil on a butt and shame on their professional associations for not policing them better. Its a lack of self-policing among themselves that is partly responsible for the messy system we have now. We had to wait until the 20th century for evidence based practice?

The difference in your examples are adults v. children. Also, what is reasonable to one person is not to another. Why should I let you dictate how I will have my children? Are you coming to my house to raise them, too? And why did you give me a general? Because you didn't like my choice of delivery? I though it was my birth.

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Specializes in ob/gyn, L&D, motherbaby.

We have just started doing elective c/s in the past year or so at my hospital. We had a new doc to come in and I guess where he came from he routinely had done them. I must admit that I have mixed feelings about this subject. I can't blame anyone for not wanting to hurt. But c/s have risks too. It is major surgery. If I had been given the choice, I would have probably have chosen a c/s too. But, in 1996 I didn't have that choice. I also didn't have the choice to get an epidural. My hospital only did intrathecal, and I progressed too fast. I begged for a c/s, at the time. Although, I did end up delivering lady partslly with a 4th degree. Not at all fun. If I had to go through it again, I would probably choose to labor, if I could have an epidural, that is, and it work!

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Specializes in NICU.
we have just started doing elective c/s in the past year or so at my hospital. we had a new doc to come in and i guess where he came from he routinely had done them. i must admit that i have mixed feelings about this subject. i can't blame anyone for not wanting to hurt. but c/s have risks too. it is major surgery. if i had been given the choice, i would have probably have chosen a c/s too. but, in 1996 i didn't have that choice. i also didn't have the choice to get an epidural. my hospital only did intrathecal, and i progressed too fast. i begged for a c/s, at the time. although, i did end up delivering lady partslly with a 4th degree. not at all fun. if i had to go through it again, i would probably choose to labor, if i could have an epidural, that is, and it work!

that's what i don't understand about this whole thing - there is pain with c-sections. it's major abdominal surgery and there is post-partum pain. it's just trading one pain for another, in my opinion. to me, avoiding pain doesn't seem to be a reason to choose surgery - it's going to hurt one way or another.

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That's what I don't understand about this whole thing - there IS pain with c-sections. It's major abdominal surgery and there is post-partum pain. It's just trading one pain for another, in my opinion. To me, avoiding pain doesn't seem to be a reason to choose surgery - it's going to hurt one way or another.

Gompers dear, I hesitate to respond because I hate it when people tell their labor stories to pregnant women.

But to answer just the question about pain - for me, post-partum cesarean pain was doable. It was different than labor pain. It could be medicated away. I was in control of it. Now I realize that I learned alot about muscles after my surgery, like I couldn't even clear my throat w/o using abd muscles and I was surprised by that. But I could take some meds and it would get better.

For me, the three "natural" labors I went through to have my first three were more about having no control - the pain took me over - I didn't like that feeling. I would get through one uc pain and then knew another was coming and I could do nothing about it. And the pain is unlike any other - even the pain after a cesarean.

I made jokes about my 4th pregnancy - getting an epidural at 2 cm. Having a cesarean. I ended up with an emergency cesarean . . . be careful what you wish for, right? ;)

There is a difference in the pain of labor and the pain of a cesarean . . .and the truth is there are woman who don't view it as I do and have had both and prefer a lady partsl delivery.

Everyone is different - some of the women I help during labor are simply naturals and amaze me. Some of the women who have had cesareans and are up and about so very soon amaze me.

Having said the above - I still don't think we should be doing cesareans for no good reason.

Now, don't take anything I said to heart - you will have your own experience and don't let anyone else take anything away from that.

Best wishes - steph

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I've had both babies by emergency C-section, and wish that the VBAC with baby #2 had worked. I prefered the labour (23 1/2 hrs and 30 hrs) to the post-op pain and blood loss. It's not like having major abdominal surgery doesn't hurt! I can't understand why women aren't better informed by the OB/GYN. I loved my epidurals, though.

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I agree with you Gompers.

I have had 2 c-sections and 2 lady partsl deliveries (with only small amounts of nubain). I will take the pain of a natural labor over the pain and nastiness of an incision infection that takes weeks to heal (not to mention the hassle and nastiness of cleaning it....but we won't go there) or the makes-you-want-to-die spinal headache that lasts for hours and hours, or the clot that "pops" 3 days after surgery through the incision. I don't think women know that these things can happen. Many think it will be an easy thing, no major pain, no complications, etc. That just simply isn't true.

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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?

Ummm... 6 weeks early to avoid stretch marks? With that logic, I'd have had to give birth at 18 weeks gestation.

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I agree with you Gompers.

I have had 2 c-sections and 2 lady partsl deliveries (with only small amounts of nubain). I will take the pain of a natural labor over the pain and nastiness of an incision infection that takes weeks to heal (not to mention the hassle and nastiness of cleaning it....but we won't go there) or the makes-you-want-to-die spinal headache that lasts for hours and hours, or the clot that "pops" 3 days after surgery through the incision. I don't think women know that these things can happen. Many think it will be an easy thing, no major pain, no complications, etc. That just simply isn't true.

Well, there ya go .. . . everyone has a different experience. :D

I had an epidural so no spinal headache. My incision didn't get infected and in fact healed fast and with not alot of pain. I am still numb there, which is weird but not bad. No clot.

So for me a cesarean was no real big deal. That doesn't negate your experience at all. I didn't like labor pains - but I did it 3 times.

steph

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