Elective caesareans judged ethical by group of doctors: do you agree?

Great Debates
21

Weighing in as someone who has had both a csection and a vaginal delivery…

Daughter #1 was born via csection after 50 hours of labor (during which I had pitocin, interthecal morphine, and antibiotics) and three hours of pushing. She never descended - despite the best efforts of my midwife and my awesome doula, she just wasn’t in the right position. She weighed 9 pounds, 12 ounces and had a 14.5 inch head.

My recovery was hellish. I was in significant pain for months. It affected our breastfeeding relationship (although we ultimately kept at it and succeeded). It was not fun, and it was not easy. Luckily, I did manage to avoid an infection; my SIL ended up back in the hospital with a very bad infection after her csection, and my cousin also had a terrible infection in her incision.

Despite all that, when I got pregnant with #2 I decided that a scheduled csection had to be easier recovery-wise than what I went through, and I definitely did not want a repeat of the “long labor ending with a csection” scenario. I switched to an OB who is a very skilled surgeon. She said she believed VBAC to be safer for mom and baby but that the choice was up to me. I had her schedule the csection the earliest possible day – July 1st, when I would be 39 weeks (she wouldn’t do it any earlier).

So I am scheduled for an elective repeat csection at 9 AM on July 1st. At 11 PM on June 30th, my water breaks. We immediately leave for the hospital and I am in HARD labor. I decide that when we get to the hospital, I will let them check me – if I am less than 5 cm dialated, we will go for the csection, but if I am 5 or greater, I’ll get an epidural and see how I progress. When I get to triage I am begging for help (thank goodness our doula beat us to the hospital); they check me and I am 7 cm. I ask for an epidural and they start the IV. By the time they get me to a room, I am 9 cm - no epidural for me! A few more contractions and I am complete and ready to push. I start pushing about 1 AM and she is born vaginally at 2:18 AM. She weighed 9 lbs 7 oz with a 14.5 inch head. I had an episiotomy and hemmorhoids from hell.

Having been through both, there is no, no, no comparison between the recovery from a csection and the recovery from a vaginal birth. A csection is major abdominal surgery. Even with the episiotomy and the “bottom problems”, a vaginal birth is so much easier to recover from. I breastfed daughter #2 10 minutes after she was born (with daughter #1 it was an hour or more before I held her and attempted breastfeeding). An hour after my VBAC, I was able to eat a sandwich (for the csection I was on a liquid diet for 36 hours) and then take a bath (after my csection I had a catheter and an IV for 24 hours and I only showered after they were removed). Then I got to help with daughter #2’s first bath (I didn’t even get to see daughter #1’s first bath, they gave it to her in the nursery and the nurse wouldn’t let my husband videotape it for some reason). I was well enough to go home after only 36 hours in the hospital (with my csection I was in the hospital for 4 days afterward, enduring the interruptions, noise, and bad food that go along with a hospital stay).

VBAC certainly isn’t for everyone. I think you can have a very satisfying cesarean birth. I also think you can have a very traumatizing, disfiguring vaginal birth. Really, there’s no ideal way for them to get out of there.

One big reason why I wanted to go for the repeat csection with #2 was the control factor. I knew exactly what time the baby would be born, and I didn’t have to go through the scary unknown of labor. Do you think that’s a big reason why women are opting for purely elective csections?

Some doctors (namely Dr. Jennifer Berman, co-host of “For Women Only” on Discovery Health Channel…she had a traumatic vaginal birth with her first child and opted for a completely elective csection for her second) say that having a csection will prevent gynecological and urological problems down the road (prolapse and incontinence). I suppose some women might be thinking along these lines. Others may be thinking that a vaginal birth often comes with a tear or an episiotomy, which could affect her sex life…better to have the scar tissue north of the border, so to speak.

I just had a friend who had a long, tough vaginal birth. She, like SnoopyFan, wished she could have had a csection. I told her she had the right to feel however she wanted about her birth experience, and that she certainly could talk to her doctor about an elective csection for #2. But I, for one, would MUCH rather have had a vaginal birth than a csection for my first, even if it meant vacuum extraction and/or a big tear/episiotomy. In my mind, having been in both places, there really is no comparison in terms of recovery.

take care,
hill

22

Jackmani:

Actually, my wife’s Ob says it’s not uncommon. We’re friends and he treated my wife with the care a plastic surgeon would use.

In fact, he told us he was closing the wound with those fancy inside stictches used by plastic surgeons, rather than the staples most folks get.

Finally, he is from a school of surgery that is very fast. I shit thee not, because I timed this: From the moment the anesthesiologist dropped his finger giving my doc the signal to cut, to the time my wife was in the recovery was 9 minutes.

I asked him why the rush and he told me that he is not rushed. Watch his hands, he’s never in a hurry, he is just maximally efficient.

The speed cuts down on infection, complications, and generally produces an excellent heal with minimal scarring.

23

Duhhh, OKay. Me try unnerstand.

[/quote]
The person who pays $750/month for health insurance (the national average, according to the NYT) may not have even the airfare to fly off to Rio ($611 RT from my US city) to get reasonable medical care at a reasonable price. Obviously, I have more options than the average insured guy.
[/quote]

So, if you lose your arm in a traumatic accident, you’re going to put it in an ice chest and buy ticket to Rio?

Who the flying fuck on a popsicle stick do you think you’re kidding?

Sure you can. I can get whatever I want with a phone call, because as a patient I have a relationship with a competant Doctor.

You’re kind of missing the point. I don’t want some Mafia doc, or failed Veterinarian or third world doc 5,000 miles away as my primary care physician.

But if it works for you, there’s always the Darwin Awards.

I appreciate your willingness to remove yourself from the food chain.

24

I was under the impression that VBAC was actually getting less dangerous. Some advances in the way the c-sections are done were making the healing process more reliable and uterine ruptures more rare. I’d have to look it back up, but I thought there was a change in either the preferred incision site or the orientation of the incision which made the uterus less likely to rupture in a VBAC. I’ll see if I can find something on this, but we were looking at stats in the late 90’s when I first ran across this info.

Enjoy,
Steven

25

I can’t stop laughing over the “too lazy” comment. Whee!

I think that fear of pain is a big factor. Sure, a c-section is major surgery, but moms-to-be know they’ll have anesthesia for the procedure. Women don’t know what a c-section recovery is going to feel like, but they assume, since they never hear about people screaming and groaning after surgery, that it will be less than the pain of labor.

C-section recoveries are not all the same. I had complications during surgery and still did pretty well. I know women who had a c-section under more optimal circumstances and were debilitated afterward (couldn’t climb stairs, for example).

I don’t care about me being “sliced open;” my concerns would be for the baby. Under normal circumstances, a vaginal birth is supposed to be better for the baby, and breastfeeding gets off to a better start. Moms need to know that they are making a choice that may not be optimal for their babies. But then parents make those choices all the time, don’t they?

If I were to have another baby, I’d go for the c-section, which I am allowed to choose based on the first outcome (and luckily, there are still a few people around, including my doctor, who wouldn’t consider that a frivolous, unethical, “lazy” choice).

A bigger issue, for me, is the burden that modern women are placed under by medicine and by society to “do it right.” There are implicit standards and expectations that there is a perfect way to labor and deliver and recover. Have a c-section, and you’re part of the epidemic of “needless” ones. What, baby was too big? Nonsense, that’s much rarer than people claim. If only the mom chose a midwife, or walked more, or waited longer before coming to the hospital, or refused pitocin, or didn’t have the epidural, or insert-your-reason-for-blame here, a vaginal would have been successful.

Christ, people, it’s hard enough as it is. Some leeway, please.

26

I hear dads are now “allowed” in the room with the mom during c section. My kids mom (and I) would have sure appreciated that.

27

Got a question for Qadgop the Mercotan, or any other health care professionals here- what exactly is an elective C-section? Does it only include those performed for completely non-medical reasons-fear of pain, convenience, etc? Or is it any scheduled C-section? It makes a difference, because it seems to me that a scheduled C-section can be performed for medical reasons and still fall short of being “medically necessary”. And the answer as to whether a particular C-section is ethical greatly depends on the reason for it- the C-section that is scheduled because there were problems in a previous delivery that are expected to recur is completely different from one that is scheduled so that the mother doesn’t have to chance missing some planned event.

28

Got a question for Qadgop the Mercotan, or any other health care professionals here- what exactly is an elective C-section? Does it only include those performed for completely non-medical reasons-fear of pain, convenience, etc? Or is it any scheduled C-section? It makes a difference, because it seems to me that a scheduled C-section can be performed for medical reasons and still fall short of being “medically necessary”. And the answer as to whether a particular C-section is ethical greatly depends on the reason for it- the C-section that is scheduled because there were problems in a previous delivery that are expected to recur is completely different from one that is scheduled so that the mother doesn’t have to chance missing some planned event.

29

Question for all the folks who say, “It’s totally up to the mother to decide, everyone else butt out.”

IF it’s taken for granted that c-sections have a higher risk to the baby

and

IF the reasons for the mom wanting one are NOT medical (purely elective)

Does this scenario change or not change your opinion?

When I give my opinion I am assuming both of these things. A lot of other people keep talking about how they had a high risk of blah blah and thus had to have a c-section.

I’m talking about a totally elective one. You know, the kind in which the mom says, I want this baby to be born on our anneversary, so mark me down for the 12th!

I think it would help the debate if we were at least talking about the same issue.

autz
(3 all natural deliveries, due in January with the 4th)

30

As far as the health service here considers them, an elective procedure is anything which is not an emergency.

So that would be ALL scheduled c-sections (and by scheduled we could just mean the next day after an emergency OB appointment) for ANY reason.

Including: multiple births, breech presentation, maternal diabetes, cephalo-pelvic disproportion, foetal health problems, maternal health problems, previous c-sections, as well as the too-posh-to-push brigade (who are smaller than you might suppose).

Damn right it’s ethical to procede with a c-section if it’s in the best interests of your patient or the foetus. It’s unethical to put a women through labour if you think that it is inevitable (or very probable) she will need an emergency c-section at the end.

Before proper c-sections childbirth was a marvellous, natural process that killed a high percentage of the women (and babies)who endured it. In parts of the world where access to medical care is difficult, it still does.

I think if you can do it vaginally, you should. But there is a vast grey area where it might be ok to go ahead vaginally, but a c-section is also indicated. For that, I think you have to allow a woman (and her partner and doctor) to decide what the best choice is.

Many people, especially people who like to be in control of the situation, would prefer a scheduled c-section, to the possibility of a complicated labour and an emergency procedure. I can’t really blame them.

I’ve heard too many horror stories of the bad old days when they only performed c-sections when they absolutley HAD to, and the poor results that approach had, to think any other way.

31

Scylla, let me say you are one of my favorite posters, and I read your original post about your wife’s csection. It sounds like she has a great OB who is truly a skilled surgeon.

So I just want to clarify what you are saying here: are you saying that once the anesthesia was working, your wife’s OB made the two incisions (external and internal), delivered the baby, removed the placenta, “cleaned out” everything, stitched up her uterus, put it back in her abdomen, stitched her external incision, and had her out the door and into the recovery room in NINE MINUTES?!?

Nine minutes from anesthesia to baby’s delivery I can totally see. But the entire procedure, from cut to final stitch, in nine minutes? I’m sorry, I just can’t believe it. It took them 30-45 minutes to stitch me up after the baby was born, which from what I’ve read is pretty average. Heck, it probably took them 9 minutes alone to count all the sponges/clamps/etc to make sure everything was accounted for and nothing was left inside me (the only part of the procedure that truly freaked me out).

take care,
hill

32

By the way, in reading several websites the generally accepted definition of ‘elective c-section’ is that it has to be "without medical indication."

Not non-emergency. Not medically suggested but not required.

NO MEDICAL INDICATION.

Just so we’re all on the same page here.

33

Hill:

Yep. nine minutes.

34

I’ve had one of each type of delivery and found the recovery to be no problem either way (it was a medically indicated C-S, not an elective one). At work I’ve had vag deliveries (try to) stay in bed for days and have had C-S’s up and about 6 hours post procedure (and vice-versa).

Personally I don’t care how the kids gets out as long as all are healthy. Sometimes I think folks place too much emphasis on the type of delivery, when that is really just a very small part of being a parent.

35

Our first child was delivered 9 weeks early via csection. My wife’s recovery was very wuick. She was driving after two or three weeks, she went back to work (briefly) a short time after that. None of this eight weeks crap for her. Our second child was also csection, although the doctor waited til she was a week pst the due date to schedule it.It was a lot easier in the early stages this time, mostly because we weren’t under stress from a 9 week premature delivery. The recovery time was tougher this time, but that was also due to the fact of our older child. The doctor felt that the risk of surgery was far less than the risk of vaginal delivery, given my wife’s history etc.

We felt comfortable with the doctor and trusted his opinion. It was the right thing to do.

36

<I hear dads are now “allowed” in the room with the mom during c section. My kids mom (and I) would have sure appreciated that.>

My husband was in the room with me. He came in right after the anethetist was done putting the meds in my back.

He was standing at my head, talking to me when I asked him if he was going to watch (we had discussed it before hand and he said, “I might. Let’s see how it goes”) I asked him, “Honey, when are they going to CUT me?” I had been bracing myself because I’ve heard one too many times, “it won’t hurt” or “you’ll just feel some discomfort!” HA! He said, “Honey, they already did!” From there, I got a running play-by-play from the hubster of what was going on. Complete with a “they’re tucking your uterus back in your body!” “Thanks dear, but that’s a tad more than I needed to know!” giggle If they would have allowed a mirror (which I didn’t think to ask about the first time), I would have watched too.

I can back up Scylla’s assertion that it took only about 9 minutes. My husband even made a comment about wanting to go fishing with my surgeon because of the wonderful knots he was tying, and how fast/accurate/fascinating it was watching him. He said the man had a regular “cat’s cradle” of thread (or whatever the sewing substance was) going!

I made the usual “from her mother’s womb untimely ripped” jokes and discussing recent movies with the surgeon’s supporting cast. Even had a room full of student nurses (with my permission to be there) who came by after the birth to chat and play with the baby.

My husband fully intends to be there for the birth of our second daughter by c-section in January. I can’t wait to hold her!

37

Thanks, pyffe.
I missed out, but that’s ok. I got two great kids. :slight_smile:

38

hill o beans, a scheduled c-section and one after a long labor are two very different animals. I’ve had both, and the scheduled one (7 months ago) was much, much easier. It didn’t take very long–I was in the operating room for about 45 minutes, and that includes the conversations beforehand and the numbing up. The recovery was a snap–I held baby g within a couple of minutes, was with her the whole time, was up and walking around very quickly (by the end of the day), and had zero problems with nursing. There was almost no pain within a couple of days.

The first one, after 24 hours of labor, wasn’t so fun. I was worn out by the time they did the surgery, and baby was too–she needed some help. We didn’t get to see each other for awhile. It took a long time to recover. She did nurse well, though.

I’m glad you got to have such a good vbac. I would have liked to try it. But I would be inclined to say that your c-section problems were more about the 50 hours (!) of labor beforehand than they were inherent in the surgery (not that I know anything, so don’t listen!).

39

Perhaps this should be moved to MPSISMS since it seems now to be a ‘post your c-section story here’ thread.

Is there still a debate?

40

autz: I know someone who scheduled a c-section because her husband had a business trip overseas near her delivery date. He couldn’t reschedule. She got her doctor to agree to deliver the baby by c-section early to guarantee that the father could be there. Is that more what you’re talking about–I mean, a situation we could chew on?

Maybe the reason this has become a “personal story” thread is because it’s so damned rankling to have the OP suggest that c-sections are the “lazy” way out.