My wife and I disagreed on this subject the other day so now I ask the teeming millions for the write answer. If an expecting mother is past the date where she can safely have her child (I forget the correct term for the date), can she elect for a cesarean or does there have to be a risk to mother or child before the doctors will operate.
I’m not sure of the policy on this, but having a cesarean in not easier than having a baby vaginally. The mother is bed-bound for at least six weeks following the birth, a cesarean is major surgery.
Well, the mom isn’t bed-bound for six weeks (they make you get up the next day), but you do feel like shit for a good six weeks, or more. You do need to rest more after a section, of course, though.
It’s major abdominal surgery, for crying out loud! I can’t imagine any woman choosing a section over trying to deliver vaginally.
I had one each way, and let me tell you, I’d choose vaginally any day over another section.
Let’s see…a catheter in your back, one in your bladder, and an IV in your arm. Flat on your back; you can’t move. No pain, just a sensation of something going on down there.
I’ve heard stories of women who tried to sit up too soon after surgery and got a raging headache from the epidural.
The pain after…oh, man, let me tell you. Sore, itchy, stabbing…you name it. The whole range of pain experience!
You do get a neat wide elastic band to wear around your belly for a while, but still.
Try breastfeeding a baby with a healing incision across your abdomen. It hurts.
I didn’t feel like myself again for at least 3 months.
As for not being able to deliver safely past a certain point, if a woman is under an OB’s care, he will induce labor at a certain point. I can’t imagine letting a woman get so far past her due date that she couldn’t deliver vaginally.
I have to go get the end result of my c-section in bed 
, but I will be back later.
wrong about the bed bound. after my c-section in 84, I was in the hospital for a week, but that was a longer than usual stay. I had weight restrictions for the aforementioned 6 weeks (no more than 10 pounds. Tough since my son weighed more than that at birth).
Was ‘off work’ for I think 8 weeks, but certainly not flat on my back.
Back to the OP. The preferred (or at least this is what a friend of mine got) was pictocin (sp?) a drug that induced labor.
dammit Kinsey I tried typing faster… (and you didn’t mention my personal favorite part of the whole deal - after 18 hours of nonstop labor that didn’t work, then the c-section, they waited until after the drugs had worn off before coming in to press on my tummy to expell the rest of whatever was in there :eek: - even in my weakened state, I was able to push the very large nurse off me…)
Neither of my kids was especially anxious to leave the womb - both were late. Both were induced labors and vaginal births.
Ok…maybe I was wrong about the bed-bound, but feeling like crap and a lot of rest is needed after any major surgery. A vaginal birth is much, much, easier on the mother. I don’t know who in their right mind would opt for a C-section. My situation was a bit different than the majority, I think, I did need to spend six weeks in bed, and like Kinsey was not back to normal until about three months after.
My thought is not that it’s easier for the mother, but easier for the doctor. With malpractice lawsuits on the rise, I figure that a doctor would rather perform a cesarean then a natural birth because the risk factor is lower. Now what I want to know is if there needs to be a reason for the operation or can a mother just decide to have one (even though it’s better to have a baby naturally).
wrong, wrong, wrong…
A c-section is much riskier than a vaginal birth. In an ideal world, they would only be done when they were truly necessary, when the risks associated with abdominal surgery were outweighed by the risks of not performing this intervention. Unfortunately, (and malpractice suits probably do have something to do with it) many women end up with surgery that they probably didn’t need.
True post-datism is extremely rare. We tend, here in the US, to be overly eager to rush babies out of the womb when they fail to appear “on schedule.” Your doctor would be unlikely to agree to a c-section merely because you were past your due date. He or she would be much more likely to try to induce labor first. Unfortunately, women who aren’t ready to go into labor often fail to do so, even when we try to force them. Failed inductions cause many c-sections.
Just FTR, I was in bed for six weeks before my c-section. Bed rest for complete placenta previa, which was the reason for my section when my son was born.
With my daughter, I walked back to my room, about an hour after she was born. I felt much like myself within a couple of days.
I think (no cites, but they are out there) that from the 60’s thru the late 80’s, many OBs were doing more sections from a lawsuit fear, but have now cut back. They’ve realized it’s much better for mom to at least try to deliver vaginally, rather than just cut her open for no good reason.
OK, let me ask the question this way. If an expecting mother went to her doctor and demanded a cesarean, would the doctor oblige her or does there need to be a reason for one to be performed?
I have heard of at least one case where a woman requested and received a surgical delivery of her child because she wanted him to be born on an astrologically auspicious day.
The pendulum is starting to swing the other way in obstetrics in the states today. For a long time, there was a push to cut the c-section rate as low as possible, and to have women attempt vaginal births after c-sections, and the section for either the physician’s or mom’s convenience was becoming “something we just don’t do” to many people.
But lately, given the number of failed VBACs requiring emergency sections, and given the modern tech which has reduced the morbidity and mortality associated with sections to approximately that of vaginal births, there is developing a counter movement, inspired in part by the philosophy “give the customer what they want”. It hasn’t gone far yet, and I don’t know how far it will go, but it’s out there. Personally, I always preferred doing a vaginal delivery over a section, but that’s just me.
I’ve read that in some South American counries, C-Sections have reached the level of status symbol. There are apparently whole high class practices that do nothing but cesaerians.
[waving hands wildly to get Ace’s attention in amongst all the C-section horror stories–pipe down, ladies, you’re scarin’ the children… 
]
Yo! Over here!
I believe the answer to your question is, “No, a pregnant woman usually cannot simply demand that her baby be delivered by C-section, if there’s no medical reason for it.” This is because a C-section is, as several people have pointed out, major abdominal surgery (that’s in big frickin’ capital letters, okay? “Major Abdominal Surgery”). You can’t usually walk in and demand to have a C-section performed any more than you can walk in and demand to have a bowel resection done, if you don’t really need one. “Yeah, take 4 inches off the ileum, please…”
Vaginal delivery is by far the safest and most comfortable route for the mother. Usually, no reputable doctor would agree to perform one if it weren’t medically necessary. There’s enough of a problem with malpractice lawsuits as it is for C-sections that are judged medically necessary. Imagine the paperwork involved with a C-section that went wrong that wasn’t necessary to begin with.
But they do a lot of things differently in South America, I understand.
[sub]…and out in La-La Land…[/sub] :rolleyes:
Postterm pregnancy (>42 weeks) occurs about 8-10% of the time, normally. These days we tend to induce at 41 weeks, if the dates are good and mom wants to.
I agree that you probably just can’t come in and ask for a c/s without some indication. Oddly enough, we did have a patient who was a VBAC candidate who wanted a repeat c/s because she feared the pain of a vaginal delivery. The baby, however, had other plans, and was at 2+ station (that is, just about out) by the time we saw her. We explained the risks of a VBAC to her in a hurry.
By the way, we encourage ambulation on post-op day #2, and usually send them home on POD#3 after a c/s.
Dr. J
Maybe you (or one of the other MDs on the board) can explain this to me. Naegele’s rule is, as we know, completely arbitrary. A Harvard study in the 1980’s found the median length of pregnancy (in healthy women with good prenatal care) to be 41 weeks plus a day. And even though most OBs will tell their patients that 2 weeks on either side of the due date is “normal”, they seem to get all twitchy when the baby doesn’t appear by 40 weeks. Why are you folks so eager to induce at 41 weeks?
robinh:
According to my textbook, Beckmann, et. al. Obstetrics and Gynecology:
–20% of truly postterm newborns demonstrate postmaturity syndrome, which includes loss of subcutaneous fat, long nails, scaly epidermis, and meconium staining of the nails, skin, and cord.
–25% of postterm infants are macrosomic; that is, they weigh more than 4000 g. This can lead to altered glucose and bilirubin metabolism, as well as increasing the risk of birth trauma, particularly shoulder dystocia, clavicle fracture, and brachial plexus injury.
–Amniotic fluid volume peaks at around 36-37 weeks, and diminishes by more than half by 42 weeks. This can lead to fetal distress, as well as impingement of the cord.
–40% of postterm infants demonstrate placental changes consistent with diminished function.
–The risk of meconium aspiration is increased in postterm pregnancy.
My guess is that, at 41 weeks, the risks of induction start to be outweighed by the risks of the above. It’s also a good time to induce because even if you happen to be off by a month, you’re at 37 weeks, which is well within the comfort zone.
The book goes on to mention that while induction is an option at 41 weeks, many physicians feel that the patient really should be induced by 42 or 43 weeks. It also mentions that modern monitoring methods make it less logical to be dogmatic about the cutoff dates, and that many docs advocate allowing the pregnancy to continue as long as there is evidence of fetal well-being.
(I’d like to thank you for asking, BTW–it will almost certainly be worth a few extra points on my next quiz!)
Dr. J
Thanks, DoctorJ. I should probably tell you that I am a natural childbirth educator and, therefore, have a very strong bias toward the natural process. But talking with physicians, particularly those who are in the educational process, helps me to understand the medical viewpoint.
My question is, what percentage of the babies who are born after an induction are “truly postterm?” My understanding is that true postdatism is quite rare and that the greater majority of the babies who are yanked out just because the pregnancy went beyond 41 weeks are actually just fine.
I am also concerned that the risks of induction are being woefully minimized. A lot of inductions just don’t work. Either they don’t get the labor going or, if they do, the labor stalls and you end up with a section. Pitocin inductions are often very painful, with contractions that are overly strong and too close together, leading to an increase in epidurals.
There was an interesting study done with fetal lambs regarding hormones that are released by the unborn lamb at the onset of labor. A group of lambs had that part of the brain that produces the hormone destroyed in utero. In the unharmed control group, all the ewes went into labor after the lambs released this hormone. None of the ewes with the altered lambs ever went into labor and were eventually delivered by c-section. This suggests that the unborn baby has a great deal to do with the natural process of labor and that labor may not be able to proceed properly if the baby isn’t ready.
I had 4 days of on and off labor before my son was born. I am convinced that my body did that in order to produce enough joint-softening hormone to allow my pelvic bones to spread enough to accomodate his enormous (14cm) head. If we had tried to augment that labor I’m sure it would have failed, because I wouldn’t have been ready. And his head size would probably have been given as the reason.
Explanations like “macrosomia” are often given for why a labor has failed after an induction, but I wonder if the true cause of the failure isn’t more often that the mother and baby simply weren’t ready yet?