A bit of a spinoff: When is a C-sec essential? - Page 3

[The Lucky One]

Well, if I am reading it correctly the diagnosis occured at the onset of labor when the woman would start bleeding profusely. The first time it happened to a woman she was tending she had no idea what was happening and the woman died. But she thought about it a lot and realised the only hope was to deliver as fast as possible. So she would watch closely and as soon as it was possible she would deliver the placenta, swiftly perform an internal version and pull the baby out by his/her feet. I have no doubt it was highly unpleasant for the mother but still, better than dying.

Yeah, but what if the mother were only, say, 2 or 3 cm dilated when the profuse bleeding occured? Then what?

Sorry to stray off topic, but as someone who is dealing with previa, I found that to be interesting.

lisa

[Greaseball]

There's no way I'd take the risk today. I'm glad there was a chance at survival back when there was no surgery, but I would not even consider trying a vaginal birth with full previa today!

Of course, many times the placenta will move upward as the pregnancy progresses, so no need to resign yourself to surgery in the first few months.

[crazy_eights]

This thread brings up a couple thoughts in my mind. Part of the reason that many people think "well, there might be other unnecessary c/sec's, but mine was necessary" is.... THEY ARE RIGHT. The problem is that many, many of the c/sec's that we have today are caused by inappropriate use of interventions. Elective inductions, induction b/c mom is 41 weeks (or 40), induction b/c baby is "too big", "too small", "too much fluid", "too little fluid", routine amniotomy, admitting mom when not in active labor, early epidurals.... the list goes on and on and on. The problem is that many of these interventions (esp. in a first time mom) can lead down a slippery slope to where a c/sec actually DOES become necessary! And this is by no means a condemnation of people that had the above interventions. Only the routine use of them by practitioners *who should know better*!!!!

As for why c/sec's are often scheduled for 38 weeks, it's b/c OB's like to do them before the head gets engaged in the pelvis as it makes the surgery easier.

[veganmamma]

Thank you Chava, I feel like I say that in so many other threads-- I guess I forgot to say it this time. You are right.

[stafl]

Originally posted by pumpkinhead
'Necessary' or 'Avoidable' are just words. In this discussion I think they mean essentially the same thing. It's not nomenclature or terminology that is the point of the discussion. That said, it *IS* important that we choose our words carefully esp when discussing a subject that so many find so provoking, and so a very valid point.

I think this is a valuable and civil discussion and I want to thank everyone who has contributed stories or information! I'm learning LOTS!

I think the point I'm trying to make is the difference between being reactive and proactive.
I know that my c-section was totally necessary. I've said it before and I'll say it a hundred more times. BUT it was also probably avoidable, had I not had the intervention avalanche that led to the surgery that perhaps saved my daughter's life.

Language is a very powerful tool. When we say a c-section was not necessary, we are reacting to something that happened in the past that cannot be changed.
When we say a c-section may have been avoided, and discuss the ways this could be accomplished, we are being proactive and might just help prevent a future c-section from happening.

And I have to echo everyone else in congratulating us all on remaining civil and keeping this discussion from heating up! It is such an emotionally-charged topic, and I'm impressed with the entire tone of this thread.

[Piglet68]

I wanted to add my voice to those congratulating us all for a civil and informative discussion.

I usually stay away from these threads because I'm a very happy C/S mama and I feel "out of place" on a board of natural birthing advocates, even though I share the same views as so many of you regarding the overmedicalization of birthing.

So many good posts here, but I like tabithas alot - we really do need to empower ourselves. And, of course, we all have our individual thresholds. I'm sure that if I were more set on having a vaginal birth, and didn't have such a fear of pain, I might not have chosen the C/S route. I made my decision not just with facts and statistics, but knowing myself as a woman and a person and how different outcomes might affect me and my birthing experience (including the emotional ramifications of passing on what is, at best, an embarassing social disease, to my baby). For some, having a C/S is a heartbreaking loss of a dream, for others it's a lifesaving and even enjoyable outcome.

Regardless of our choices, they should all be based on sound knowledge and facts, and an awareness of the cascade-of-interventions effect that so plagues birthing in this society.

[kama'aina mama]

Originally posted by The Lucky One
Yeah, but what if the mother were only, say, 2 or 3 cm dilated when the profuse bleeding occured? Then what?

Sorry to stray off topic, but as someone who is dealing with previa, I found that to be interesting.

lisa

More T

There aren't a ton of details in the account Ina May gives. All I know is Schrader managed to save 8 out of 10 which is astonishing. There is some "common wisdom" if you will, that in cases of previa labor tends to go REALLY fast... as though your body knows what is up and is doing it's best to make it work.

[pumpkinhead]

Originally posted by stafl
I think the point I'm trying to make is the difference between being reactive and proactive.
I know that my c-section was totally necessary. I've said it before and I'll say it a hundred more times. BUT it was also probably avoidable, had I not had the intervention avalanche that led to the surgery that perhaps saved my daughter's life.

Language is a very powerful tool. When we say a c-section was not necessary, we are reacting to something that happened in the past that cannot be changed.
When we say a c-section may have been avoided, and discuss the ways this could be accomplished, we are being proactive and might just help prevent a future c-section from happening.

I totally see your point and totally agree! Well put Mama!

Yes, C/S can be BOTH at the same time, necessary AND avoidable.

[crazy_eights]

Originally posted by kama'aina mama
There is some "common wisdom" if you will, that in cases of previa labor tends to go REALLY fast... as though your body knows what is up and is doing it's best to make it work.

I think it is more than "common wisdom". Blood is a uterine irritant and apparently in the '40's was even looked into as an induction agent. When we have a woman who comes in with uterine "hyperstimulation" (contracting 'too long and too hard') one of the first things we think of is abruption - which of course causes blood in the uterus.

[kama'aina mama]

I love learning new things! Thanks mom2six!

More on topic: This issue of how to address sections with questionable genesis is one a struggle with a great deal. Tow of my sisters had sections within a few months of each other in the 70's for CPD. One of them is somewhat open to discussing it and giving some thought to the possibility that it could have been avoided, one is totally closed on the subject. Why do I care? Well, the one who is unable to talk about it at all has two daughters in their twenties and I worry a lot about the message they have gotten about their own bodies abilities. I would hate to see them have avoidable sections because of that.

[its_our_family]

Originally posted by Mom2six
uterine "hyperstimulation" (contracting 'too long and too hard')

I didn't know there was a term for it!! This is why I had my first c/b. I was pitocin induced/enhanced and I ended up becoming supersaturated. My last contraction was between 60-90 minutes with no break in between and like a 102 on the monitor. My ob refused to turn of the pit to see what would happen. When they would turn it down the contractions would normalize. But he refused to turn it off. Tracy's hb was fine and he was doing great. But they were afriad I was going to rupture because of the stress that the pit put on my system.

So, I guess my c/b fell under avoidable and necessary. I guess we'll never know if my son would have been born vaginally without the induction.

[lollaleeloo]

Originally posted by its_our_family
My ob refused to turn of the pit to see what would happen. When they would turn it down the contractions would normalize. But he refused to turn it off. Tracy's hb was fine and he was doing great. But they were afriad I was going to rupture because of the stress that the pit put on my system.

Ho. Lee. Crap.

I got chills reading this because you describe my dd2's birth like you were there for it. I was also stuck in an endless contraction and I begged them to turn down the pit, which had been going full blast for God knows how long, but they were adamant. They said that if I wanted to to have any chance at a vbac, they needed to get the baby out sooner not later, so the pit must stay on. I came *this close* to having a section for the same reason as you, but for 2 lucky breaks. One: my daughter had a heart like a metronome, tolerating labor exceptionally well. I'm told that if the the strip had shown so much as a hiccup, I would have *absolutely* been sectioned again. After 2 days of hard pit labor, it's a miracle she never appeared to register distress.

But my biggest stroke of luck happened when the pump eventually ran dry. Without the pitocin onslaught, the contractions normalized very quickly into manageable peaks and valleys again (instead of remaining plateaued at the peak). While they sent someone out to get another pump, I tested pushing gently with the contractions again, and lo and behold, the baby started moving down. 25 minutes later I had my baby.

I'm convinced that the monster contraction artificially frozen mid-peak ultimately served as an obstruction to birth, because as soon as my uterus was allowed to fully unclench, the baby resumed her descent. Until then, I could have pushed till my eyes popped out, but against a muscle siezed into rigidity by pitocin, I never stood a chance. This is all 20/20 hindsight of course, but it's hard not to see the irony of my hospital induction consisting largely of the very elements that put me at greatest risk for the very rare rupture I was seeking to avoid, and the repeat c-section I narrowly escaped. Live and learn.

I look back on the whole episode and really only have one lingering question: Why were the doctors so reluctant to turn the pit off, even after they already acknowledge that it may have been doing more harm than good by that point? How could they be so worried about the risk of imminent rupture that they suggest c-section, yet refuse to turn off the most likely cause?

Sort of on a related note, but does anyone know the rationale behind their fear of labor slowing down or stopping for a bit at the end, even though I was engaged and fully dialated? I don't get it. I thought it was normal to have a lull just after transition.


----
Edited to remove the following paragraph because I felt it implied that I think they tricked me (something which I don't believe). The mistaken assumption was on me for projecting my wishful thinking that I could opt out at any time.
The reason I'm asking is, prior to induction, I was told that if the pitocin didn't take, they would turn it off and send me home. I certainly didn't take that to mean that if the pitocin *did* establish contractions, it had to stay on, and dosages can only go up. In fact, I only agreed to the induction under the mistaken impression that I could opt out at any time.

[veganmamma]

I just wanted to say a metronome heartbeat isn't good, to my knowledge, you want variations in heart tones, but not certain types of decels. My guess is that if she had metronome heartbeats she might have been a repeat c. Still learning about FHTs and responses though. Chava knows, Chava knows!

Good for you for growing such a strong baby, btw.

[lollaleeloo]

Whoops, sorry. Didn't realize 'metronome' heartbeat was a medical term. I only meant that her heartbeat stayed strong throughout the whole ordeal. She's such a little peanut, too. You'd never suspect such a warrior.

[veganmamma]

:LOL It's not really, there is a name for it, metronome is a good description. I remember what heart ones are bad and what are good, but I forget all their names. Lesse, early decels, late decels... :LOL

I get you about warrior girl in a peanut's body. My dd had a long labor to deal with and she came thru like a champ with no decels until her cord was a bit compressed. She then proceeded to be the most adorable, alert little angel i've ever met.

[its_our_family]

Originally posted by lollaleeloo
I'm convinced that the monster contraction artificially frozen mid-peak ultimately served as an obstruction to birth, because as soon as my uterus was allowed to fully unclench, the baby resumed her descent.

I look back on the whole episode and really only have one lingering question: Why were the doctors so reluctant to turn the pit off, even after they already acknowledge that it may have been doing more harm than good by that point? How could they be so worried about the risk of imminent rupture that they suggest c-section, yet refuse to turn off the most likely cause?

As for the first part of the quote..... i completely agree!! My son was pretty high up (posterior also). The ob and the nurse got into a verbal argument IN MY PRESENCE about how he was handling the pit. In fact she turned it down several times without him in the room just to give me a break. I wish I had known more and pushed him more to turn the pit off.

As for the second part..... I was told that there was no going back. That once they started the pit if they turned it off then there was a chance labor would stop and that is what they didn't want.

What infuriates me is that my ob arrived 6 hours AFTER he said he would. He barely assessed me, broke my water, and turned up the pit. He came back about 2 hours later The pit had already started to "not like me" when he broke my water. He never mentioned that we should stop and perhaps try and induction (or wait for labor) another day. He went right ahead and broke my water giving us no way to turn back. The next thing I know my contractions are lasting for forever and I only get relief when the pit is turned off. I then had my c/b (which I was fine with by the time it happened because of the pit)

I also ranked high on that scale they have. You know, the one that says if you are a good candidate for induction. I was already 3cm and over 75% plus I was already contracting. I never got passed that 3cm and 75% once they started the pit.

Like you said, Live and learn.... I wish I knew then what I know now...

[lollaleeloo]

{{{megan}}}
I'm inclined to think that pushing the doctor wouldn't have done any good. I was only spared because they ran out of pit; they were never going to turn it off. :


If anyone out there knows the rationale behind the No Turning Back The Pit No Matter What Even If It Means Surgery rule, clue me in.

[KKmama]

Wow. I never got to the labor or pitocin phase (I had an emergency C due to fetal distress that was happening without there even being any contrax... long story). Anyway, I've kind of felt like the silver lining to a VBAC (the way my drs. and I have agreed, anyway) is that there will be *no* pitocin...

I'm sorry for what you both went through.

[crazy_eights]

Originally posted by veganmamma
:LOL It's not really, there is a name for it, metronome is a good description. I remember what heart ones are bad and what are good, but I forget all their names. Lesse, early decels, late decels... :LOL

I think what you mean is lack of short term variability. It means that the beat to beat rate doesn't vary. The presence of short term variability is one of the most reliable indicators of fetal well being (more so than decels being an indiction of a fetus in distress).

And if what you ladies describe as happening during your inductions was what was going on - well, somebody wasn't doing their job. One of the things you are supposed to check for is that the uterus is soft between contractions. (Not that I doubt what you are saying, but sometime perception of what is going on can be different than what the medical types are looking at - that's another tangent. But suffice it to say I wish I had a dime for every woman that told me "My contractions were peaking OFF THE MONITOR!!!!" If it's external monitoring, doesn't mean a thing. It doesn't read contraction intensity)

[crazy_eights]

Originally posted by lollaleeloo
[BIf anyone out there knows the rationale behind the No Turning Back The Pit No Matter What Even If It Means Surgery rule, clue me in. [/B]

Um, stupid medical mentality? :LOL Truth is, not all places do this. Some places they acheive adequate contraction pattern and then once you reach 5 cms turn the pit down at the rate they were turning it up (the assumption being that your body will kick in by then). However, the problem is with the prevalance of epidurals, this equation doesn't always work. The epidural is busy supressing contractions and usually the woman needs more pitocin to overcome that effect. So it's a vicious cycle. And since many drs. and nurses are used to seeing most women with epidurals, it never occurs to them that they could actually turn the pit down/off. It sounds like your OB subscribes of the "more is better" route to induction - which has been disproven time and again by research. Another name for this philosophy is "pit to distress" - keep turning it up until the baby shows signs of distress.