Why a C-Section?

New CCU RN · Nov 1, 2005

I think when electing to have a csection, just as in the L/D situation---when, for whatever reason, a csection appears to be needed--- the decision needs to be collaborative. By that I mean, the physician and patient/family discuss the reasons a csection is indicated, and together, reach the decision to proceed. I also think there needs to be a medical need, not just "because I want to do it" as a reason.
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On the flipside of that coin, I also get frustrated with physician convenience as a very common reason. I have seen physicians lean VERY heavily on patients who are vulnerable and trusting, to proceed with this procedure, often ill-advisedly. I think that is horrible.
Yes, maybe a separate issue for you---but for me, is appropos: If we as the public are being asked to pay for these things, I would like careful and consistent auditing as to reasons WHY such elective procedures are being performed. I think we are fellow consumers and people being asked to pay for such things have that right.
Like I said, I believe very strongly in freedom of choice, but also I think we all must be reminded : along with choices come concommitant responsibilities, incurred both by medical professionals and the informed consumer.

We are in agreement that it needs to be collaborative. We are in agreement that physician convenience should not weigh into the decision making. We are in agreement that the woman needs to know the risks and benefits.

Who gets to decide to have an elective c/s? To me it should be the person that elected to bring a child into this world.

When it comes to insurance coverage, I think that it can be a slippery slope - having a baby after all is an elective procedure... In my opinion, health care insurance should cover health care. This really can open a can of worms - and I do believe everyone should recieve the same care regardless of financial abilities.

However, here is a 28 year old lets say having her first baby. Has never had a medical problem in her life. She works, has health insurance from her work and her husband's work. Has paid boatloads more into the pot than it is going to cost for her c/s. Why should she have to pay above and beyond b/c she is having a c/s electively?

The problem is our health care system, pharmaceutical companies, when we are talking about costs. I find it hard to believe that allowing elective c/s to be covered by insurance would drive up health care costs that much to actually cause it to negatively affect the everyday person. And I say this because there is a cause and effect - if there are more elective c/s there will be less incidents of complications due to labor. Of course more c/s means more incidences of the complications that can occur with a c/s - however, I would be interested in an the research with regard to when a surgical complication occurs how often the c/s was urgent or emergent. I'd bet it would be a lot higher with the rush quick quick get the baby out type scenario.

edj02 · Nov 1, 2005

Hi, it's me, the original person who posted this obviously heated discussion. I am glad to see that everyone has opinions on both sides of the fence. One of you asked me if I had ever had a C-section, so could I really comment on the pain involved? I have not had a C-section, but I did have my appendix removed when I was 16. That was only a 1-inch long incision on my abdomen, but I wanted to die I was in so much pain just from being cut. I have been in the OR for several C-sections now, and that incision is definitely much bigger than 1 inch. I can only imagine how much it must hurt. It is also interesting that one of you mentioned Britney Spears...it was actually her uneducated comments regarding childbirth that prompted me to post. Also, going along with what another one of you said...in the family care unit, my lady partsl delivery patients seem much more alert and able to care for their babies. I had one patient just last week that had a C-section and I never once saw her even look at the baby, much less hold her. I'm not saying that every single c/s patient is like that or that anyone is a better mother than anyone else, but these are just my observations. Also...I don't know what it is, but the energy and the atmosphere in the delivery room of a lady partsl delivery simply cannot be replicated in the OR, or in the recovery room of the OR. If you have not felt that same energy, than I can see why maybe a nice convenient c/s seems desirable. You will be missing out on an experience you can never get back though.

Thanks!

TweetiePieRN · Nov 1, 2005

There is a VAST difference in expenses incurred in csection delivery versus lady partsl delivery. I would rather not ask the public at large to have to bear the cost for elective procedures. Many of us can barely afford current insurance premium costs as it is. JMO, as always.

FYI I do agree with what you are saying! But, for that sake of argument, what do you think about this: I work in oncology and we get 80 yr olds on Medi-cal (medicaid for california) getting the whole 9 yards of chemotherapy, neupogen shots (those are thousands of dollars per shot), the whole gamut of care, being in the hospital for several days if not a week or too (all because they are trying to beat cancer at 80 yrs old). Should the public pay for this? :)

SmilingBluEyes · Nov 1, 2005

Well yes, the argument of elective procedures and who so-called "deserves" them can get heated. I see elective csection as not all that different than elective surgeries and procedures of all sorts. I think people ought be held to the responsibilities they incur along with the choices they make, whether they be the health care consumer or the medical professionals. Unfortunately, the concept of personal responsbility is severely lagging behind "rights" awareness in this country.

Personally, If I were to run for any office of responsibility in government, I would fight---hard--- to bring responsbility back in the "rights-and-convenience"-driven healthcare environment of today. But I am not under any illusions it would be easy. Turning the tide is enormously taxing and often fails, I know.

Personally, folks, I am enjoying this lively debate. I see all here as being respectful and I really appreciate the views that oppose mine. I am open to hearing what others "on the other side of the fence" have to say, and trying to learn why they feel as they do. I appreciate those of you who have offered very valid and reasonable arguments on both sides. Just wanted you to know.

SmilingBluEyes · Nov 1, 2005

To the OP, there are very interesting studies on the effects surgical delivery have on early bonding and breastfeeding experiences----I should try and dig them up. It is yet another facet that I find interesting in the debate.

SmilingBluEyes · Nov 1, 2005

I will say also, truly 'emergent" csection needs can be subjective. The language is being re-defined by the ACOG and AWHONN organizations, as we speak. I think that is good, really. It puts us all on the same page.

I have to say: I don't see too often, a truly emergent need for csection that did not often follow elective inductions or other KNOWN medical complications/pre-existing conditions that already justified its need. Or, the case of a person with zero prenatal care and presenting with complications we are just discovering upon admission---this person may present the need for an "emergent" csection.

Sometimes, in certain cases, we proceed with an induction anyhow---hoping the lady partsl birth will avoid such complications---mild and uncomplicated gestational hypertension cases come to mind here for me. I still work with physicians that will do a trial of labor if early csection risks outweigh the relative safe course of lady partsl trial of labor. I think this is prudent and reasonable, but becoming increasingly rare.

I also realize we are talking about separate issues, here.

The "need" for a healthy primip with zero known complications electing to have surgery versus another who has known health complications/problems w/the fetus undergoing csection---separate and troubling issue for some of us. I think it's horrendous to elect to do surgery (in this case) for a person with zero known medical history making it necessary.

suzi_h · Nov 1, 2005

I think vanity and sexuality are ridiculous excuses for elective c-sections. What about doing kegels to tighten the muscles back up? I have had 3 kids, lady partslly, and med free. I have to say, I have returned to normal :yeah: . I was up and ready to go the next day. There's only going to be one person that will have access to my lady parts for the rest of my life, I don't think he'll care that it's not as snug as it was when we were 18. As far as vanity is concerned, I would think a scar across my abdonmen would be more of an issue then a stretched out you-know-what. Besides, I'd rather be in pain for a few long hours then a few long days! What happened to the magic and suprise that comes with child birth? There's no way you can feel the same emotions when you are completely drugged vs. being completely alert. It's selfish and pure laziness to opt for a c/s just b/c you can, without any medical reason for it. Parents who want scheduled deliveries are going to be in for a big shock about the actual parenting part.

Just my opinion.

Suzi

TweetiePieRN · Nov 1, 2005

What is the opposite of an elective c-section? Mine wasn't elective because the baby under stress really overdue, etc.

SmilingBluEyes · Nov 1, 2005

I have found it helpful for me to try not to think in black and white terms such as "opposite" or "equal".

The reasons for csection are many. In your case, if diagnosed as "fetal distress" ---this would be an actual medical diagnosis (defined increasingly clearly by the ACOG). This is documented and treated with cesarian section as determined by your health care team and with your collaboration. Hope this helps.

SmilingBluEyes · Nov 1, 2005

I think vanity and sexuality are ridiculous excuses for elective c-sections. What about doing kegels to tighten the muscles back up?
I have had 3 kids, lady partslly, and med free. Parents who want scheduled deliveries are going to be in for a big shock about the actual parenting part.
Just my opinion.
Suzi

I will not say these are "ridiculous" to those who hold these concerns. They are VERY valid. I have seen women suffer stress incontinence and even in severe cases, fecal incontinence, and other nasty complications from difficult lady partsl deliveries. As a GYN surgical nurse, I have seen many, many women undergo bladder suspensions and A/P repairs, it became so unliveable for them. I also know of cases where poorly-healed 4th-degree laceration repairs (extending into the anal sphincters) had to be actually surgically re-done years later. it's no walk in the park for these women----so, No, I would NEVER blow off such concerns; they are valid.

BUT----- those electing to have what they want when they want it---yea, they are in for a shock as parents, but then, aren't we all as new parents???? :-)

TweetiePieRN · Nov 1, 2005

I think vanity and sexuality are ridiculous excuses for elective c-sections. What about doing kegels to tighten the muscles back up? I have had 3 kids, lady partslly, and med free. I have to say, I have returned to normal . I was up and ready to go the next day. There's only going to be one person that will have access to my lady parts for the rest of my life, I don't think he'll care that it's not as snug as it was when we were 18. As far as vanity is concerned, I would think a scar across my abdonmen would be more of an issue then a stretched out you-know-what. Besides, I'd rather be in pain for a few long hours then a few long days! What happened to the magic and suprise that comes with child birth? There's no way you can feel the same emotions when you are completely drugged vs. being completely alert. It's selfish and pure laziness to opt for a c/s just b/c you can, without any medical reason for it. Parents who want scheduled deliveries are going to be in for a big shock about the actual parenting part.
Just my opinion.
Suzi

What about those of us who needed a c-section because the baby was in trouble?

Regarding the "scar across the abdomen". Have you ever seen someone's c/s scar? Mine is almost completely faded away and it is soooo low on the abdomen, you can't see it unless your face is in that area. I think the stretch marks on me look WAY worse than the almost non-existant suture line. (and my stretch marks aren't even that bad).

There's plenty of magic and surprise when you have a c-section! I got to see my baby's face for the first time and his hear cry...I don't think it gets any more magical than that :).

As for "being completely drugged out". I had a spinal, I was totally "with it". So basically you could say the same thing about a mother who chooses an epidural in regards to being drugged out. Maybe you're referring to people who have gen anesthesia, because I did have a friend who had an emergency c/s who did get completely knocked out.

My delivery was scheduled...parenting is probably no different for me than it is for vag deliveries, right?

Realistically, you and I can assume all we want because neither of us know any different. I have never had a vag birth and you have presumably never had a c/s. So, we personally have no real way to compare, I guess. :)1

suzi_h · Nov 1, 2005

What is the opposite of an elective c-section? Mine wasn't elective because the baby under stress really overdue, etc.

When I was referring to "elective", I meant a person who has been planning a C-section from day 1 of the pregnancy. Obviously if the baby is under any kind of stress, it should be an option. But, I think there should be medical reason for it. So, in my instance, the oposite of elective c/s would be lady partsl delivery. I think fear of child birth is a completely assinine reason for a c/s (i.e Britney Spears). :twocents:

Suzi

I wanted to add, I hope I didn't offend any of you, I absolutely understand concerns like incontinence and other complications. I am referring to women who just don't want the inconvience of child birth.