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Induction as "prep" for planned C/S?!

post #1 of 7
Thread Starter 

I've been meaning to ask about this (story was told to me about 4 months ago and it smelled suspicious, but I admit I could be missing something)...


Totally crazy-making, but a very close friend of mine was told she needed to have a C/S right away (during a regular appointment) because her son had IUGR.  I can't remember, but I think it was before 40 weeks-- maybe 38 or 39.  Son was something like 6 lbs, 12 oz...  IOW, not all that tiny, and especially not if I recall correctly, and he was born <40 weeks (first time mom). 


That aside...


She was absolutely clear on the fact that they were going to do a C/S-- so I am as sure as I can be, without actually being her, that this was not her misinterpretation, per se.  She was then told that she needed to be induced first, and was hooked up to pit, etc. for several hours before they wheeled her to the OR for the planned C/S.  I was totally dumbfounded and told her that I had never, ever heard of a woman being induced prior to a scheduled C/S-- not as part of the C/S process, anyway*.


Is there some crazy new (or old) technique, or something I'm missing, that would make induction before a planned C/S... make any sort of sense, whatsoever?


I told her that, unless I was missing something critical, my best guess is that there was a horrifying degree of miscommunication at work, to the point of malpractice...  That either A) her OB had ordered her prepped for a C/S, and someone misunderstood it as an order for induction (and no one admitted the mistake) or B) her OB/whomever decided, what the heck, let's give her a shot at laboring before we section her... but never told my friend that, nor told her that induction and C/S were not part of the same process. 


She KNEW she was having a C/S from the time she stepped in the hospital, but was induced anyway.  Whether or where there was a miscommunication or what, one thing she knows for sure is that no one ever said, "Okay, we're sectioning you now because the induction didn't work."  Because she went into surgery believing the induction was part of the C/S process.  


Anyone?  Thoughts?  Trust, I'd love to be wrong on this one...




*I want to be really clear that my friend had a lot of resentment for her OB "care" and had already concluded that she had been treated poorly throughout her pregnancy.  She was already p!ssed and was interested in my opinion as a layperson with an above-average understanding of birth, interventions, etc., and she always appreciates bluntness in such a case.  Just meaning that I would have been much milder and more non-committal when speaking to just about anyone else-- I don't make it my business to go around picking apart birth stories!

post #2 of 7

sounds weird to me....I have never heard of that!

post #3 of 7
Im a hospital-based midwife and I've never heard of that. Although I do work in Australia and some of our practices are different to the US. I still can't think of any clinical reason for it though.
post #4 of 7

I suspect that there was a misunderstanding.

There is something called a contraction non-stress test.  Oxytocin is given to cause contractions and the fetal response is gauged.  If there were concerns about fetal wellbeing due to poor placental function, this would make the decision to go to c-section clear.

I have told patients before that there is a concern and delivery is indicated.  If the degree of suspected compromise is great enough, I would offer to go directly to C-section.  However, if there is desire to attempt a vaginal delivery, I would do a contraction non-stress test.  The patient receives oxytocin until contractions start.  Often the fetal heart rate is atypical or even abnormal.  Because the initial contractions are often too mild to actually achieve cervical dilation, I then recommend an "elective" c-section, although in this case it is not truly elective, but the best chance to deliver a non-compromised baby.

If this is the case with your friend, there could definitely be more clear communication.  However, oxytocin before a c-section is not unheard of, particularly when there is concern for compromise in the settling where a vaginal delivery is desired.

post #5 of 7
Thread Starter 

Haelmoon-- such a test wouldn't take several hours, would it?  I'd have to check back with my friend, but I believe it was 3-5 hours' worth of pit.

post #6 of 7
It actually can take several hours for the contractions to start up. Oxytocin doesn't make contractions appear suddenly.
Either, it is unfortunate that the time was not taken to make sure you friend understood what was happening. I hope she and the baby are well.
post #7 of 7
Thread Starter 

Interesting.  Like you said, even if that were the case for my friend, clearly it was not communicated, because she was told she was definitely having a C/S before she was ever admitted to the hospital.  If that really were so-- if there were no way they weren't going to perform a C/S-- it sounds like there'd be no need for the test you described.  Of course, she was treated pretty cr@ppily by the medical establishment throughout her entire pregnancy and birth anyway...


Baby (her first and only) is totally fine.  My friend ended up having a somewhat elective hysterectomy last year... not directly d/t the C/S (or not entirely), but her experience with pregnancy and birth certainly didn't leave her feeling much loyalty to her uterus.  gloomy.gif

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