Why a C-Section?

allnurses Guide · Nov 4, 2005

Of course, it would never happen because docs would just make up a reason.

Yep - and that is just too sad.

I think having an elective cesarean for no medical reason should not be covered either. But as you said . .

The line gets tough to draw though - preventive mastectomy in a woman with the genetic risk seems to me to be a cost effective way to go. Rather than lumpectomy and chemo and radiation and lots of hospitalizations. I know for sure that if I got any kind of breast cancer, both those puppies are coming OFF!

Boy, gastric bypass . . . . that is a hard one. Obvious health benefits to reducing weight but it is no guarantee. Local lady had one - but her eating habits never changed and she ended up weighing more, after an initial wt. loss.

I've said prior in this thread that after 3 vag births and finding myself preggers again in my 40's I sort of longed for a cesarean . . . hate the feeling of labor pains and the fact that my body is out of my real control (Lamaze - hooey!) I did end up with an emergency cesarean - I did breastfeed my son after delivery - it did hurt but not debilitatingly so. I was just glad my son was alive and healthy - the surgery was not a big deal. For me.

steph

TweetiePieRN · Nov 4, 2005

I've never had a health plan that covered pregnancy or birth control pills unless they were medically necessary for another reason. Breast reduction isn't really elective for many since it is done to correct pain. Gastric bypasses are elective for some people. My insurance company wouldn't pay for it for me since I'm a normal weight (ok, I could stand to lose about 20 lbs, blame it on the cookies at work!). Preventive mastectomies would not be covered for everyone either I imagine. Where do we draw the line? I don't know. I know that we do draw a lot of lines already. I would have no problem with another one being drawn at c-sections with NO medical indication. Of course, it would never happen because docs would just make up a reason.

My health plan totally covers all the pregnancy costs (didnt cost me a single dime for the entire time, also covers my BCP. I don't know if they mastectomies are covered under my coverage since I have had no need to check. My insurance co. does cover gastric bypasses too.

nurse4theplanet, RN · Nov 4, 2005

I've never had a health plan that covered pregnancy or birth control pills unless they were medically necessary for another reason. Breast reduction isn't really elective for many since it is done to correct pain. Gastric bypasses are elective for some people. My insurance company wouldn't pay for it for me since I'm a normal weight (ok, I could stand to lose about 20 lbs, blame it on the cookies at work!). Preventive mastectomies would not be covered for everyone either I imagine. Where do we draw the line? I don't know. I know that we do draw a lot of lines already. I would have no problem with another one being drawn at c-sections with NO medical indication. Of course, it would never happen because docs would just make up a reason.

EVERY medical insurace carrier I have had, has covered birth control pills simply because i believe they acknowledge that it is cheaper than paying for a delivery.

Breast reduction may not seem like an elevtive procedure but it is classified that way by the insurance company. My best friend was a full EEE in 7th grade!!! She was constantly in pain, could not excercise, and developed a humped posture from the weight alone but she was 23 before she found an insurance company that would pay for a breast reduction...and this was only because of the numerous x-rays, chiropractor visits, and pain meds that they were having to shell out money for, IMO.

Some elective procedures that were designed to be for emergencies only may go too far (like gender reconstruction), but that depends on your oppinion really. And everyone is entitled to one.

Fergus, you certainly have not been JUDGEMENTAL with your oppinion and have been quite respectful with your posts.

There is nothing better than a good debate, with knowledgeable posters, who recognize the difference between stating the facts and making personal attacks based off of emotions. I have learned sooooo much through this thread.

But I still maintain my position

TweetiePieRN · Nov 4, 2005

Exceptions to the rule though. Extra digits and ears being pinned back is generally seen as correcting a deformity. They are along the lines of skin grafts for burn victims or the repair of a cleft lip/palate. They are elective, but also corrective. Circumcisions are in a class of their own. It's a deeply ingrained cultural matter, just like birth. There are certainly examples of elective procedures a doc will do just because the mother wants it done, but there are hundreds more that they wouldn't do so I don't think it does anything to support the argument that sections are only the mother's choice because she is the baby's decision maker. It's just another issue entirely.

I would think that ears being pinned and removing an extra digit would be cosmetic. How does having big Dumbo ears interfere with ones daily life (other than teasing). I would think having an extra finger would come in handy :rotfl:

Burn victims...don't they need skin grafts, because of the infection factor of having no skin and just a huge open wound? (Burn nursing is not my forte:uhoh21: ). Cleft palate...don't they have a hard time eating with the palate being open? Those can be considered medically necessary (I would assume).

fergus51 · Nov 4, 2005

\Fergus, you certainly have not been JUDGEMENTAL with your oppinion and have been quite respectful with your posts.
There is nothing better than a good debate, with knowledgeable posters, who recognize the difference between stating the facts and making personal attacks based off of emotions. I have learned sooooo much through this thread.
But I still maintain my position

Me too:chuckle

My plan doesn't cover contraception because it's a cheapy plan. I basically have insurance just so I am covered if I get into an accident or something. I don't really use the medical system here for anything because I use the Canadian system still (I know, I'm a bad Canadian, but I like my doc back home and it's free as long as I pay my premiums).

fergus51 · Nov 4, 2005

I would think that ears being pinned and removing an extra digit would be cosmetic. How does having big Dumbo ears interfere with ones daily life (other than teasing). I would think having an extra finger would come in handy :rotfl:
Burn victims...don't they need skin grafts, because of the infection factor of having no skin and just a huge open wound? (Burn nursing is not my forte:uhoh21: ). Cleft palate...don't they have a hard time eating with the palate being open? Those can be considered medically necessary (I would assume).

I would call ear pinning strictly elective (I have big ears btw, and I'm fine), but I know some doc would stress the psychological reason it has to be done and that would make it non-elective. Similarly, I have had women who have been severely sexually abused choose to have a scheduled c-section and the medical indication was listed as maternal anxiety (a psych reason is considered valid like a physical reason). I know it's a grey area isn't it? Extra digit removal is the correction of a deformity, so I wouldn't think of it in the same class as strictly cosmetic ones. Same as cleft lip and palate. A lot of kids eat just fine with a cleft lip/palate (I sent one home last week and she's a little fatty). It can affect speech, but it doesn't always, so in some cases you could argue it's elective, but again it's a deformity so I wouldn't think of it in the strictly elective category.

Q. · Nov 4, 2005

If you read my entire post, I acknowledged this point.

I did read your entire post and I don't see how you really accounted for that fact other than stating that because abortion was legal and women were allowed to "choose" to kill their baby, women should be allowed to deliver in any way they choose, since obviously grunting and retractions in a baby is much better than killing it.

I don't think those 2 really equate and in my opinion, still doesn't account for the effects on the baby at all.

Your argument of "well, mothers can choose to kill their babies; I'm simply choosing to have a section which would be not the BEST for the baby, but compared to an abortion it's better..." doesn't seem logical to me at all.

flw_03_20 · Nov 4, 2005

I think that since a lady partsl delivery is the natural way to go about childbirth I think that woman should at least try to have a lady partsl delivery. If they can't take the pain then why are they even having children.

There are some circumstances that do not allow a lady partsl delivery if it is going to be unsafe for mother or baby, but I do not think that women should beable to decide whether or not they want a csection or a natural delivery.

TweetiePieRN · Nov 4, 2005

I think that since a lady partsl delivery is the natural way to go about childbirth I think that woman should at least try to have a lady partsl delivery. If they can't take the pain then why are they even having children.
There are some circumstances that do not allow a lady partsl delivery if it is going to be unsafe for mother or baby, but I do not think that women should beable to decide whether or not they want a csection or a natural delivery.

"lady partsl delivery is the natural way to go about childbirth". Fair enough. So if a person conceives out child unnaturally thru in-vitro or artificial insemination...should they not have kids. Lets say they don't want to have sex to make a baby...should they not have a child?

"If they can't take the pain then why are they even having children?" What does this statement mean? Having kids is a total pain, so if someone can't deal with birth pain...they can't deal with children, they shouldn't have them? Makes no sense to me.

I was wondering if you have children?

mstigerlily · Nov 4, 2005

Yep, we use duramorph spinals too, and our postpartum orders say d/c foley between 18-24 hrs post-op. The pain control with a spinal seems to be very good though, those who had a trial of labor first with an epidural for the section seem to be hurting a lot more, a lot sooner. Some docs also place the On-Q pumps for local anesthetic but the bags are awkward and they tend to leak at the insertion site. I think they help for local pain around the incision but not much else.

When I say flat on their backs for 12 hrs that varies, I have moms that are able to dangle a few hours after and ambulating well in the room within 12 hrs but generally there is some dizziness and nausea upon changing positions, sitting up, moving the head, etc which can lead to a risk for falls or vomiting. Since I work night shift, when I get a fresh section I generally see how they are feeling, how pain control/nausea is going and if they are ok, get them up then to dangle at least. If not, I've found remaining flat and moving as little as possible helps avoid the dizziness/nausea and I have them rest through the night and get them up around 5 or 6am instead.

Our sections stay 4 days and I rarely have one who wants to go home early. Sometimes on the third day but rarely before. Usually they appreciate and need the nursing care.

The only trouble I ever have with the lady partsl deliveries is sometimes they are too puffy or numb to pee and need a straight cath. They go home after 2 days and sometimes sooner, especially the natural births who have kids at home. They generally are ready to go the minute they deliver :)

Janet, it depends where I am. Some do better than others. Generally our MDAs use DURAMORPH in the spinal, which necessitates keeping a foley in for 24 hours (due to affected innervation around the bladder/urethra) and to be on Sat Monitors for just as long. The pain control varies w/Duramorph spinals. I have seen some women need little to no narcotic intervention---others need PCA narcs within a few hours after delivery. It can vary. Of course, such women have to be watched even more closely for over-sedation/and have their repers monitored that much more.
No one on my unit must remain on her back, and when the BP stablizes out, can be in any position she may choose. All are encouraged to ambulate within 12 hours of delivery, as well. Almost all go home in 48 hours or just a bit more.

Altalorraine · Nov 4, 2005

I am astounded by the judgmental attitudes here. Our job as nurses is to educate people about relative and absolute risks and alternatives and then support them as *they make choices* which are in their best interest. We are not there to decide what their best interest is. (Suppose a woman wants a section so her dying mother can be there for the birth; suppose there are childcare issues; suppose she has a precious six weeks of maternity leave; suppose her spouse is going to be deployed for a year; suppose she is uncomfortable with the controversial practice of VBAC?)

I'm all for lowering the section rates by promoting healthy, sane birth practices, but if a woman says she wants a section it is not my place to second guess her reasons and assume she is vain or weak or lazy or somehow destined to be an inadequate parent. Women have the right to choose to do what they want with their own bodies, including delivering their children in ways that they feel good about.

Did you know that there are places in this country where women have been prosecuted for choosing homebirth and others for *not* choosing c section because judgmental people felt they were better able to decide what was right than the women themselves?

Every one of us has a right to an opinion as a private citizen, but I think as nurses our loyalty should be with patient autonomy, and we should leave the self-righteousness behind.

Altalorraine

P.S. I can't imagine how people with these attitudes manage to take care of the diverse, high-need, high-risk, drug-taking, no-PNC, promiscuous, frequent flyer patient populations that we see so often.

fergus51 · Nov 4, 2005

Alta, with all due respect, having an opinion on something does not mean that nurses can't provide good compassionate care to everyone. I have opinions about drug use in pregnancy, yet I have been complimented on how I provide care to those mothers. I think no prenatal care is a bad thing, but I still look after those patients to the best of my ability. I mean, really, what nurse doesn't think no pnc and drug use is a bad thing? But we can still look after those patients with kindness and compassion. I can have the opinion that c-sections with no medical indications are not so great, that doesn't mean I don't care for these women like my other patients or that I try to force my opinions on them.