Portland hospitals banning elective c-sections and early inductions

Miscellaneous and Personal Stuff I Must Share
101

Sorry, I kind of made a drive-by post here, and didn’t follow up. But this bubbled back up and I saw Dangerosa’s comment.

I think that part of the issue locally is that a firm line had to be drawn as regards mid-to-long term development of the child, in addition to possible complications for the mother.

While a baby born naturally at 37 weeks may be as healthy as a baby born at 39 weeks, pre-term induced labor and c-sections add another dimension to the issue. Induced labor can be more forceful and more traumatic for the baby, and they are more likely to involve painkillers which can affect the baby. Also, pre-term induced labor has been show to increase the risk of requiring a c-section by 2 to 3 times, and c-sections pose some obvious risks, in addition to leading to potential complications for baby - I hesitate to use Wiki as a cite, but the linked section has several footnotes on these issues.

I fully support women’s reproductive rights, but I also believe that the medical community has an obligation to act responsibly as regards elective procedures. If the patient (or her partner) has a problem with their work schedule, there are labor laws protecting their rights. This should not factor into a decision about what’s medically best for mom and baby.

If one insists on having such a medically unnecessary procedure done and is willing to pay for it, there’s always Vancouver across the river - I know that comes across as horribly flippant, but there you go.

102

pbbth, assuming you’re responding to Mama Zappa’s comment about choosing a truly elective c-section - IMO, there’s nothing elective about yours. Sounds like you’ve got a lot of reasons to have one, and your doc agrees with you. Although you’ll be surprised at how you might learn to deal with all the poking and prodding in the coming months. Congratulations on your preganancy (it does get easier, my wife can attest to that), and good luck with everything else.

103

Someone offline reminded me that I’m using the phrase “pre-term” wrong - technically it means “labor before 37 weeks”. So mentally find-replace “pre-term” with “non post-term”, which is what the Wiki article discusses anyway.

104

Well, this WebMD article states that there are few women actually intiating elective C-sections. The article reminds us that ‘elective’ just means ‘not medically necessary’ and claims that it is rarely the mother who initiates the request.

105

See, I would call this medically necessary. But THIS is one that I would be worried about having to take before a review board, because ya never know. Unlike the case of the twins mentioned before, which would have no problem passing any review board anywhere.

But as long as it was scheduled for 39+ weeks, you wouldn’t have to worry.

I must say that this thread has made me rethink a bit on scheduled deliveries.

106

I think complicating the issue is the fact that c-sections required as a result of complications during elective induced labor are likely not considered elective in and of themselves.

107

If the hippie fascists could have their way we’d all be required to give birth in a bathtub at home with some stoned “midwife” dancing a prayer to The Goddess the whole time. Then we could go back to having fifty percent of babies and mothers die as a result of birth, just like nature intended.

108

Holy shit, pbbth, you have cervical cancer!? I’d be freaked out too. Are you doing OK?

109

Ditto!!!

My remark was made in mind of the “too posh to push” attitude I’ve heard of.

I didn’t notice the bit about current cervical cancer until I reread just now. Ouch :(. One more fun thing to worry about during your pregnancy :frowning: :(.

A friend of mine was diagnosed with an unusual variety - during a prenatal check! She wrestled with some very unhappy-making options, including pressure from some family members to terminate the pregnancy. Fortunately she sought better medical advice, from several Big Name specialists who both said “terminate? bwuh??? This isn’t that urgent!”.

Nonetheless, the specialists both also said “but let’s not delay things any longer than necessary”. She had amnio testing at about 36 weeks to make sure the baby’s lungs were matured enough, then she actually had a c-section and hysterectomy the same day - they delivered the baby, and then put her under and did the rest. I don’t recall the details of why they did a hysterectomy vs. just cone slicing or whatever, may have had to do with the apparent stage, or the variety.

Her son is 12 now and she’s as healthy as a horse - as is her son :).

110

BTW - you’ll get a lot of hits if you google the phrase “too posh to push”. Wikipedia mentions that in Brazil, the rate in private hospitals (i.e., I guess, mothers who have the means to pay for whatever treatment they want or “need”) it may be 80% (though there’s no citation).

Having personally had a hellish induced labor and vaginal delivery, and a pretty easy urgent-but-not-emergent C-section, I’d definitely elect for the latter if it had ever been an issue (wasn’t, fortunately!). But it’d have been a VBAC and so I probably wouldn’t have had any problems even in Portland.

111

I’m okay. My doctor wants to do a pap a couple of days after the baby is born to verify that the results of my last test are correct before she starts cutting parts out of me. She knows it is not going to be an easy thing for me to handle and wants to be doubly sure before she makes me go through a cone biopsy or anything. She was afraid I was going to kick her during the colposcopy and a biopsy will be much worse than that. After the birth and the tube tying and the cancer cell removal I’m not going back to the doctor unless I’m dying for at least 2 years. I’ve had quite enough of this medical-needle-poking-invasive-bullshit to last a lifetime.

112

Now that raises a question: can’t she just do it while you’re “on the table” - as in, numb from the epidural so can’t feel a thing, and maybe even a little loopy if they give you a li’l happy juice once the baby is out? (they gave me something to relax me once Moon Unit was disconnected… as the stress of the whole procedure had me quite reasonably jitterly).

Of course there may be many very good reasons why that’s not a great idea. Still, there’s some appeal to it :).

113

To be honest, c-section recovery didn’t seem so awfully awful to me after a few hours of natural labor (that the nurses thought was pitocin labor… with a face-up stuck baby). At the time I called it “a cakewalk”. I kinda hope that I get a (medically recommended) c-section with the next kid too.

114

Personally speaking, I’ve had one C-section and two natural deliveries, and by far the natural deliveries were way easier to recover from. Way, way, way. That said, the C-section wasn’t any worse than any other abdominal surgery. I was up and walking the next day and the incision pain cleared up after a week or so. I could live without the permanent numbness that I have where the scar is, though.

115

March of Dimes is hugely pushing the “40 week” pregnancy, which is the correct pregnancy time. You can go onto www.marchofdimes.com to find some stuff, but I’ll post a few links.

Article discussing C-section rates

Another article

But I think you women here on the Dope forget something very basic. You all think you are educated and know what you are doing and are totally confident - and the fact is, you probably are! The average woman going in for childbirth isn’t. And teen and young moms aren’t at all. March of Dimes did a survey recently amongst teen moms and something like 70% of them thought that 35 weeks was more than enough time for the baby to cook. I’ll see if I can dig up a cite.

Here is a link that will tell you a little more about it. Please note none of the links I have posted are from March of Dimes - I could post that, but I’d prefer unbiased posts.

Health concerns of the late preterm infant. “The risk of health problems due to prematurity starts to decline around 37 weeks, but doesn’t level off completely until 39 weeks gestation.”

Serious research has been done recently that significant changes happen to the brain of the baby in the last five weeks.

March of Dimes has a new model they are testing called “Centering Pregnancy” - in which women meet together with a qualified practitioner to discuss pregnancy issues. In the arenas it’s been implemented, premature birth has dropped by as much as 30 percent. Here’s a better link on Centering Pregnancy.

The rate of C-sections has increased 40 percent since 1996. What percentage of those are voluntary? We just don’t know. The data is not there, and that is another thing that is being worked on - better data. 30% of all births in NYS are C-sections, for example. There has been no research done to quanitify the risck of elective C-section compared to vaginal birth, so really there’s no way to say “C-sections are just as safe”.

I know you all think it’s about money and the bottom line but that’s really not all that’s at the heart of this, I swear. It’s coming to light more and more that baby needs every moment of time of the 40 weeks. And the fact is, people do not know this. I’m sure Dopers do, but the average woman on the street? Studies indicate it is not so. On top of it all, the second link I posted up there says that half of women who are having a vaginal birth after C-section (which is quite possible) were denied the option from their physicians because the physicians were not willing to do it.

Choice is already being taken away from women. We have no idea how many of these C-sections are warranted or even wanted. Premature birth is a huge problem and costs millions of dollars, and even babies slightly premature often have problems. Please read MarchofDimes.com for more information.

116

Sattua and MsWhatsit: It can vary so widely.

My “natural” delivery - which had to be induced when my water broke (thanks, I’m pretty sure, to an extremely rough internal exam 2 days before from the Nazi Doctor From Hell, whom I also got stuck with because the good doctor was out of town, and whom I regret hitting… well, more accurately I regret that I only hit her once)…

… led to the cascade of agonizing labor, a wait for nearly 3 hours for ANY pain relief when we found that the default preparation contained a preservative that stood a fair chance of making me stop breathing, a BOTCHED epidural (you’re not supposed to jump and scream in AGONY when that needle goes in) which didn’t work… then forceps and 3rd degree tearing that made pooping pretty much impossible without major intervention, and sitting up similarly impossible for something like 2 weeks (I ate my meals either draped across an easy chair with the plate on my chest, or lying on my side in bed). Once, I nearly passed out in the shower, I was in so much pain.

By comparison: my second delivery was an urgent-but-not-emergent C-section (baby was doing fine, but I was thinking about dying in a few days and for some reason the doc thought that was a bad idea and I didn’t have the heart to argue with her :D). So the epidural was administered more carefully, by someone competent who had actually READ my files… which meant it felt weird but didn’t hurt… the doctor had time to do things carefully without doing any excessive damage (a slash-and-grab c-section might have been very different).

Now, my recovery was helped by the fact that I didn’t have to care for the baby 24/7 within 3 days (she spent 17 days in the NICU)… and also by the fact that obviously I had a pretty major incentive to get on my feet so I could see her, on another floor of the hospital.

But all in all it was a much, MUCH easier recovery. FAR less painful both during the birth and afterward. I took precisely ONE narcotic pain pill after my c-section (in fairness, I had a dose of long-acting morphine in the epidural), while I was on a stiff dose of Tylenol 3 for most of a week after the vaginal.

Oh - and even tho the epidural didn’t work too well THAT time either, the pain was a) less severe, and b) lasted far less time, than with baby #1. The skin / muscle was numb so I didn’t feel the cutting, just very very painful jostling while they were rearranging my innards.

So my takeaway lesson was: “take your time and do it right” c-section > induced labor, “take your time and do it right” c-section > emergency c-section, natural labor >= induced labor (I assume, never having had natural labor).

And if I ever need surgery on the lower part of my body, where epidural is advised to avoid general anesthesia, I’ll say not just no but HELL no because they don’t fucking WORK on me :(.

Oh, and as an aside, if you list your religion as Catholic, the hospitals have sensors in the patient rooms so that they WILL come and offer you Communion.

While you’re in the shower.

Yep, both times, in TWO different hospitals. :smack: Next time I’m in the hospital, I’m listing Pastafarian. At least if they offer me a bowl of macaroni while I’m in the shower, I won’t feel like I’m going to hell for it!

Not that this is on-topic for the thread, just a random semi-funny thought :).

117

Well said, Anaa. I’ve been reading this thread and been quite surprised by the support for major abdominal surgery when the human female comes equipped with an opening that can be used. I’ve done a little research into this issue, too, and see that it’s both the women and the doctors that sometimes select this option without a medical reason. The issue, to me, doesn’t seem to be women’s choice - that’s sounding like a red herring to me. I would have hoped that the issue would first be the health of the baby and the mother, and convenience and choice would be much further down the list.

118

Thank you. I don’t mean to tell women their business but it isn’t so simple as “Momma wants to have baby and mean old doctor won’t let her” but more like “Momma isn’t quite sure and doctor nudges her, or momma suggests it and doctor just goes along with it.”

The thing is, that health professionals of all stripes agree this is the way to go. Hospitals are going to come to a hard stop - basically, the only way to get a C-section now is to submit the case to the head OB-GYN in the hospital, who will compare the case to a list of requirements and decide if a C-section is medically warranted. I am involved in this field and trust me, the people involved really really are concerned for the health of baby and momma.

119

The thing is - I think you’re preaching to the choir, Anaamika.

I 100% support the Portland hospitals’ decision, actually. As long as the early inductions / c-sections do have a sufficiently streamlined and rapid review process, so things aren’t delayed to the point where they cause problems.

There are, however, plenty of legitimate medical reasons to opt for an “elective” c-section; even the poster who had other health issues, including some that were “just” a severe stress reaction to any major gyn stuff. A lot of the examples cited in this thread could perhaps try a challenge by natural childbirth, but stand a significant enough risk of converting to a c-section (possibly on an emergency basis, which is not optimal).

Do I think there are too many “elective” procedures (induction and/or c-section)? Sure. I don’t know that there are necessarily all that many planned c-sections with no genuine medical need (I truly don’t know - have there been any retrospective studies reviewing such things, like “yep, warranted” or “nope, coulda avoided that one”) but I think there’s a very strong tendency to jump to the knife when things go the least bit wrong, without trying alternatives.

And elective inductions are, I suspect, far too common. I nearly had one myself - baby was looking BIG, so they were looking at inducing at 39ish weeks (when my body jumped the gun and it was no longer elective). And as a result of that induction, I had a pretty awful experience, a fair bit of physical damage, my kid was in significant distress and I nearly had cuts in my stomach AND my crotch (if the forceps had failed…).

120

Emergency c-section- one that has to be performed ASAP. Usually in labour, but occasionally not. Always medically necessary.

Elective c-section- never performed during labour, scheduled in advance, but not always without a medical indication.

I had irishbaby at 39weeks in a planned c-section.
It was my choice, but based on the advice of my obstetrician.

My daughter was born on the 9th of July- avoiding the 2 public holidays, hospital understaffing, rioting and general chaos that accompanies the 12th of July here.

It also meant I avoided what would almost certainly have been a difficult labour and an instrumental delivery or emergency c-section, based on several medical issues I have.

I have no intention of attempting a VBAC.

Vaginal delivery comes with risks and benefits- as does c-section. I believe in an informed choice.

In the UK it is almost impossible to have a purely elective “book me in next Friday- it’s the only space I have in my schedule” c-section on the NHS. The UK still has a 30% c-section rate.

I have a feeling Portland will find itself making a more flexible protocol after a few lawsuits.