A bit of a spinoff: When is a C-sec essential? - Mothering Forums

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#1 of 99 Old 03-13-2004, 03:25 PM - Thread Starter
 
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How do you all feel about C-sec's? I'm no expert, that's for sure, but here are my answers:

-prolapsed cord
-extreme maternal distress (i.e. BP, etc)
-maternal injury (spinal nerves, paralysis etc)
-extreme fetal distress (i.e. heart rate etc.)
-Extenuating fetal circumstances (very permature babe, emphalocele, cojoined twins)
-placenta previa
-placental abruption

Correct me (as I'm sure you will ) if any of these are inncorret assumptions.

That's all I could come up with. I agree that lots of these issues could be 'treatment' related in how labour and delivery are managed esp during a hospital birth.

I'd love to hear all of your insights.

P.S. I feel that C-sec's have their place and are a wonderful tool *IF* (big if) they are absolutely essential!!

Mama to Thing 1 and Thing 2.
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#2 of 99 Old 03-13-2004, 03:34 PM
 
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i think if YOU feel you needed a c/s.. Then YOU as a person probably did.. Whether it was technically medically neccesary who knows..

My 1st ds was breech.. We had him c/s.. Could i have delivered him vaginally.. Maybe.. I doubt it with the way the other 2 were... (HIgh forcepts and vaccuum extractions) but it's possible.. I would still have a c/s for breech position, but that is MY personal comfort level.. I am very glad, however, to have a VERY pro vback OB.. Who said, "So are we having this baby the right way?" when i cam in pg with our 2nd.. I was scared, but did have the vbac, and am sooo glad i did...

I don't think all the bashing of c/s after the fact that we see alot around here is very useful.. It's done.. You can learn about ways to avoid a c/s again, but NOTHING is a given...

Just my .02..

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Dyan

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#3 of 99 Old 03-13-2004, 03:38 PM - Thread Starter
 
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Whoa! My intent was NOT to bash c/s in the LEAST!

I do think a lot of the whole 'fear factor' and 'comfort level' can be largely accredited to the care and information a Mama recieves, either way (i.e. fear of a vag birth or fear of a c/s).

Mama to Thing 1 and Thing 2.
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#4 of 99 Old 03-13-2004, 03:57 PM
 
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Quote:
Originally posted by pumpkinhead
How do you all feel about C-sec's? I'm no expert, that's for sure, but here are my answers:

-prolapsed cord
-extreme maternal distress (i.e. BP, etc)
-maternal injury (spinal nerves, paralysis etc)
-extreme fetal distress (i.e. heart rate etc.)
-Extenuating fetal circumstances (very permature babe, emphalocele, cojoined twins)
-placenta previa
-placental abruption

Correct me (as I'm sure you will ) if any of these are inncorret assumptions.

That's all I could come up with. I agree that lots of these issues could be 'treatment' related in how labour and delivery are managed esp during a hospital birth.

I'd love to hear all of your insights.

P.S. I feel that C-sec's have their place and are a wonderful tool *IF* (big if) they are absolutely essential!!
Transverse Breech, Uterine Anomaly, True CPD, Some type of injury that might prevent vaginal birth, eclampsia
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#5 of 99 Old 03-13-2004, 04:35 PM
 
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The reasons you listed are pretty standard, but there are exceptions.

At my midwife appointment yesterday, she mentioned that a few days ago she had delivered a baby at home with a prolapsed cord. The birth was ready to happen and then the cord dropped, so she had the mom get into the knee-chest position, reached all the way up and got the baby out.

If I were in that situation I might have let her try it. But if it dropped well before the birth, I'd transfer. We are a 3-minute drive from the hospital, and that's how long it took her to get the baby out. If we had a big car I probably would have wanted to be on the way there, and let her try the delivery during the drive.

Transverse babies that refuse to turn are another reason, but there have been exceptions there too, where the midwife has reached into the uterus and turned the baby. Footling breeches have been born vaginally though, some in unassisted home births by MDC members.

About maternal distress/injury/deformity, I don't know. Mothers with high bp, herpes, fibroids, a few previous classical incisions, muscular dystrophy, paralysis, diabetes, and partial placental abruptions have birthed vaginally, and some of them were home VBACs.

Fetal distress is tricky; so many babies delivered surgically for this reason were born with high apgars, suggesting no distress had been present. All they have to go on are heart tones, which may or may not be true indicators of distress. Still though, I would transfer if I got those low tones during a home birth.

There is some controversy as to whether premature babies fare better when delivered vaginally or surgically. My sister was born by c/s at 29 weeks, and I think it was necessary. Babies delivered vaginally at 34 weeks have been just fine, but it probably depends on what is wrong with the baby. Contractions help strengthen the lungs and force out excess fluid.

True CPD can only be verified after the 2nd stage of labor begins, so an ultrasound or pelvic x-ray isn't really valid when done before labor starts.

I'm lucky enough not to have anything majorly wrong with me physically, so I can't imagine having a deformity or disease and then being faced with risky decisions. I would transfer during a home birth only for fetal distress, non-turnable transverse, prolapsed cord when birth is not expected to happen right away, or placenta previa/abruption.
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#6 of 99 Old 03-13-2004, 04:46 PM - Thread Starter
 
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Greaseball,

Yeah, that's pretty interesting. I guess it just proves what most of us already know: every one of us is unique and every labour and delivery are pretty unique as well. Circumstances alter cases and nothing is ever cut and dried until the fat lady sings (or gives birth as it were ). Whew, enough coloquilisms already?!


Onthefence,

What is CPD?

Mama to Thing 1 and Thing 2.
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#7 of 99 Old 03-13-2004, 05:02 PM
 
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Quote:
Originally posted by pumpkinhead
Greaseball,

Yeah, that's pretty interesting. I guess it just proves what most of us already know: every one of us is unique and every labour and delivery are pretty unique as well. Circumstances alter cases and nothing is ever cut and dried until the fat lady sings (or gives birth as it were ). Whew, enough coloquilisms already?!


Onthefence,

What is CPD?
When the pelvis is too small to pass a baby.
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#8 of 99 Old 03-13-2004, 05:03 PM
 
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.. I was totally NOT saying YOU were c/s bashing Pumpkin..

Sorry.. maybe I wasn't clear enough on that.. But i have seen a lot of c/s bashing on these here boards.. The whole.. Well you didn't NEED a c/s you know.. KILLS me.. Perhaps it wasn't medically neccesary but what does it do for the mom after the fact..

Just to clarify...

Sorry about that PH..

Warm Squishy Feelings..

Dyan

It's lonely being the only XX in a house of XYs.
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#9 of 99 Old 03-13-2004, 05:08 PM - Thread Starter
 
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Pynki,

No worries, Mama! . I wasn't offended, just wanting to clarify!

back atcha


OnTheFence,

Cool, thanks, but what do the letters stand for?

Mama to Thing 1 and Thing 2.
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#10 of 99 Old 03-13-2004, 05:09 PM
 
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I had an emergency c-section at 31 weeks with my 4 year old due to her heart rate dropping when I had my Braxton Hicks. Try going on mag and thought I was gonna have 9 weeks of bedrest in the hospital, but a couple hours later my doc wanted the baby to come out. (this is the short version)

I felt okay with the whole thing. I was able to have a successful VBAC in 2002 with out medication.

Just my experience.

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#11 of 99 Old 03-13-2004, 05:26 PM
 
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Quote:
Originally posted by Greaseball

Transverse babies that refuse to turn are another reason, but there have been exceptions there too, where the midwife has reached into the uterus and turned the baby. Footling breeches have been born vaginally though, some in unassisted home births by MDC members.
The midwife who did my homebirth delivered the footling breech of one of my friends. And I had another friend whose baby was presenting her shoulder and ultimately had a vaginal delivery. But I honestly think I would have had a c-section in that situation because her labor sounded horrible. I would have had a c-section if either of my babies had been breech because I really wouldn't have had a choice other than unassisted. I have a friend who was able to have a breech at the hospital, but the hospitals in this area are pretty conservative and she was lucky. The doctors wanted to do a c-section, but there was one who was willing to deliver vaginally.
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#12 of 99 Old 03-13-2004, 05:29 PM
 
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Quote:
Originally posted by pumpkinhead
Cool, thanks, but what do the letters stand for?
Don't quote me, but I believe CPD stands for "cephalo pelvic disproportion"-- or "head won't fit through pelvis".

HTH...
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#13 of 99 Old 03-13-2004, 05:31 PM
 
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I don't understand why some midwives won't deliver breeches, even frank breeches. What's the point of having a midwife if they are just going to have the same rules doctors do?
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#14 of 99 Old 03-13-2004, 05:42 PM
 
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Yes cephalopelvic disproportion. Fetal overlap isa sign of CPD that can be diagnosed before labor begins, but even with fetal overlap, there is a chance it is relative CPD, meaning if the baby changes position, the baby's head may fit through the pelvis. All women with suspected CPD should be allowed to labor on their own terms, it is still possible for the baby to be born vaginally in some cases of fetal overlap.
Quote:
When the pelvis is too small to pass a baby.
CPD isn't really when the pelvis is too small to pass the baby. The wording tends to further the "women's bodies are suspect" mentality. This is detrimental to women who have been rightfully or wrongfully diagnosed with CPD. The truth is, CPD is when the baby's head presents in a way that it will not fit through the pelvis. It may be that the head is too large to pass through the pelvis, that the type of pelvis won't allow for the baby's position/size, etc., but it really isn't that the pelvis is too small. It may mean there was a bad match in headelvis sizes, but the "too small" wording isn't really accurate and can be hurtful to mothers who have had a CPD diagnosis.

It is my understanding that Laura Shanley, author/activist and MDC member had at least one footling breech at home.

Transverse babies have been turned in labor; there are techniques less drastic than reaching into the uterus to turn the baby, but this is also an option.

I'm not saying that some cases may necessitate c/s, but it shouldn't be the first remedy by any means.

Herpes lesions in the birth canal at onset of labor is a reason for c/s.

Hydrocephaly causing CPD.

I just want to say that with my dd chances are I would have been diagnosed CPD, but it was relative CPD due to bad positioning and once she was moved she was able to descend and was born very quickly. I only wish my MW had taken me seriously enough to come over and move her BEFORE I was in labor for 69 hours!

Anyway, CPD is never a permanent diagnosis. The amount of CPD that is diagnosed and the amount that is true is dramatically different. IMO, one of the biggest factors in a woman overcoming CPD diagnosis, or being told before birth she is at risk, is confidence.
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#15 of 99 Old 03-13-2004, 05:46 PM
 
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Quote:
Originally posted by Greaseball
I don't understand why some midwives won't deliver breeches, even frank breeches. What's the point of having a midwife if they are just going to have the same rules doctors do?
I agree. Under my state's law breech delivery is verbotten by MWs though. A MW who does breech delivery can lose her backup and even be prosecuted. In CA, if someone dies during a felony (practicing medicine without a license) the person who did the felony is prosecuted for first degree murder. There was a MW here before midwifery was legal who was prosecuted for this and even the judge said it was a travesty, but the law was/is still the law.
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#16 of 99 Old 03-13-2004, 05:48 PM
 
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Moving this to Birth and Beyond...
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#17 of 99 Old 03-13-2004, 05:51 PM
 
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Quote:
Originally posted by Greaseball
I don't understand why some midwives won't deliver breeches, even frank breeches. What's the point of having a midwife if they are just going to have the same rules doctors do?
Not sure about other situations in this thread, but my midwife will deliver breeches in general. However, she told me that she would not deliver me if I was breech. I didn't switch to her until I was almost 40 weeks, so that is probably why. I was a little surprised to find that out, however.

Oh, here is a story that mentions the footling breech homebirth: http://www.newsreview.com/issues/ren...5-09/cover.asp
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#18 of 99 Old 03-13-2004, 06:02 PM
 
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Anyway, CPD is never a permanent diagnosis. The amount of CPD that is diagnosed and the amount that is true is dramatically different. IMO, one of the biggest factors in a woman overcoming CPD diagnosis, or being told before birth she is at risk, is confidence.
Many women who are sectioned for CPD go on to vaginally birth a baby that is larger, sometimes by 2 lbs or more.

My midwife will deliver breeches and twins, as will most of those I have interviewed. I interviewed one who said "No breeches, twins, VBACs, diabetics" and on and on. Might as well see an obstetrician.
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#19 of 99 Old 03-13-2004, 06:07 PM
 
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Originally posted by Greaseball
Many women who are sectioned for CPD go on to vaginally birth a baby that is larger, sometimes by 2 lbs or more.
Yep, it's true.
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#20 of 99 Old 03-13-2004, 06:08 PM
 
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HELLP Syndrome is another reason for a c-section to try to save both mom and babe. A dear friend of mine just went through an emergency c-section last week (she was put under general) and she was 33 wks. along. Her dd was 3 lbs. 5.9 oz and 15 3/4 inches long and is doing well.

Warmly~

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#21 of 99 Old 03-13-2004, 06:09 PM
 
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Yes, also MDC member gossamer had an emergency c/s for HELLP syndrome
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#22 of 99 Old 03-13-2004, 10:23 PM
 
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Yes, i remembered her story about HELLP and her dd. She was heavy on my thoughts last week when my friend had her baby.

warmly~

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#23 of 99 Old 03-13-2004, 10:33 PM
 
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Well, I know this example is really really rare, but Heather Mills (Paul McCartney's wife) had a cesarean at 37 weeks, and I thought she was just another idiot celebrity who wanted to schedule her birth and be done with it. I didn't realize she had metal plates and pins in her pelvis, and she had to have reconstructive surgery a few months after the birth.

I felt like an a$$ for assuming the worst about her.
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#24 of 99 Old 03-13-2004, 11:06 PM
 
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I know that paralysis is not an absolute indication for a c/sec. I know a woman that had a vaginal birth after she was paralysed, ironically enough, from an epidural in labor (she had a undiagnosed bleeding disorder and developed a clot at the site which caused nerve damage). She went on to deliver her next child vaginally despite being paralysed from the waist down.
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#25 of 99 Old 03-13-2004, 11:40 PM
 
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because for some time i suspected i might have herpes, (i dont... i had an allergic reaction to iodine used in a rape kit in the ER...long story) i can tell you the herpes is usually not a good reason for a cesarean. If you have your average OB, he or she will likely push a cesarean whether you have lesions or not Some practitioners will push acyclovir (antiviral med) on you in the last weeks if you want to deliver vaginally.

However herpes is most fearsome when it is your very first outbreak while you are in labor, something that cannot be predicted and is quite rare in monogamous pregnancies, as you can imagine. Subsequent outbreaks do not present the same danger, and babies can be born vaginally in most cases as herpes doesnt always occur inside the vagina or on the cervix, it is often external.

in addition, there is some research showing that many babies born to women with recurring outbreaks (not the mother's first) have immunity to this disease! there is a weath of alternative treatments to prevent outbreaks, and so on and so forth.

I am quite glad it is no longer a concern for me (no on to bigger scarier worries :LOL) but I dont think herpes belongs on a list of "definite" reasons for cesarean.

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#26 of 99 Old 03-14-2004, 12:04 AM
 
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T
When a c-sec is planned, why is it so often planned for 38 weeks? Why can't they let the mother go 40 weeks, and just have her come in earlier if labor starts before then?
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#27 of 99 Old 03-14-2004, 12:20 AM
 
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Tabitha, if a MW in CA who is licensed and has backup doesn't refer a client with herpes to an OB who will ultimately want to do a c/s, she will lose her backup if the baby gets sick. I agree it may not be a definite reason for c/s depending on the location and state of the lesions, but it is a big indicator. I think many practitioners are also doing the liquid banddaid stuff now where it is sealed off. I agree, it is definitely not an absolute, I should have said that in my post, thanks for correcting me.
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#28 of 99 Old 03-14-2004, 12:32 AM
 
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I had a c-section due to genital herpes. I actually had to beg my OB's (I had two, since I moved halfway through my PG) to let me have a c-section. IME, most of them say it isn't usually necessary.

The reason I asked for one is b/c I had a history of asymptomatic outbreaks, a drastic increase in outbreak frequency during pregnancy, and I refused to go on acyclovir while pregnant (there's more but this is the short version, lol). I researched the issue for weeks on end and was very comfortable with my decision.

I had a wonderful birth and recovered very fast. Of course, I'll be having another one this time. However, I don't consider myself to be an "advocate" of CS and, in fact, I am definitely of the opinion that prenatal care and birthing needs to be taken out of the hospital/medical setting as the "norm". I could go on about that but I'm preaching to the choir here, lol.

Oh, and greaseball, the reason they schedule the sections a week early (for me, at least, it was 39 weeks, not 38) is because they prefer it if you don't go into labour first. First and foremost, because if for some reason you went through labour fast and/or weren't able to get to the hospital in time you risk an emergency c-section (general anaesthesia) which is something nobody wants! Also, it is much easier to recover from a section if you haven't laboured for long beforehand, not to mention I can't imagine dealing with getting the spinal/epidural and dealing with labour pains at the same time! Finally, a small reason but..you risk having a "partner" perform the C/S rather than the OB whose been your primary care person throughout your PG. However, I'm pretty sure that if I asked to wait until I started labour that they would be okay with that (I live 1.5 blocks from the hospital, lol).

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#29 of 99 Old 03-14-2004, 12:41 AM
 
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Quote:
Originally posted by Greaseball
T
When a c-sec is planned, why is it so often planned for 38 weeks? Why can't they let the mother go 40 weeks, and just have her come in earlier if labor starts before then?
Ny OBs malpractice insurance would not let her due a csection prior to 39 weeks unless it was an emergency or their was a documented health concern, like pre-eclampsia or GD. In fact she actually gave me an article from the ACOG that recommends waiting until the 39th week. I read where a lot of people are having csections at 38 weeks, and I figure their doctors are lying on paper or dont give a rats behind.
I had a csection at 38 weeks, it was planned, and had medical reasons however my doctor made sure all her i's were dotted and I had to sign something knowing the risks.
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#30 of 99 Old 03-14-2004, 01:29 AM
 
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I don't know that a thread like this, asking this question, is educational or helpful at all. Each woman's situation is so very different - and there are so many variances to so many different complications that arise in labor and birth.

I just think that it will do nothing but create a huge division and arguments.

Just my opinion, though.
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