[Lkg4dmcrc]

From reading some things on this site, I gather that people assume that if your baby comes out of a cesarean with high apgar scores, then the cesarean was not necessary. Specifically, for those people who had cesareans due to fetal distress, do you feel that the apgar scores are indicative of actual fetal distress and necessary surgery?

 

[maxmama]

To diagnose true fetal distress, you need not only Apgars below 7 at 5 minutes but also lab evidence of hypoxic acidemia (usually defined as an art pH below 7.10 on birth cord gases). Most babies don't meet these criteria. the tricky part is that some babies look crappy on monitoring and come out fine. Other babies look crappy and don't come out fine. Monitoring is pretty non-specific.

 

[wifeandmom]

Quote:

Originally Posted by maxmama To diagnose true fetal distress, you need not only Apgars below 7 at 5 minutes but also lab evidence of hypoxic acidemia (usually defined as an art pH below 7.10 on birth cord gases). Most babies don't meet these criteria. the tricky part is that some babies look crappy on monitoring and come out fine. Other babies look crappy and don't come out fine. Monitoring is pretty non-specific.

This is what I've always heard too.

And I'll add that I read somewhere, although I cannot remember where, that 75% of baby's who *appear* to be in distress to the point of warranting a c-section actually turn out to be fine upon delivery by section.

The problem lies in the fact that there's no way to know for sure if a baby is the 1 in 4 who is TRULY in severe distress vs. the 3 of 4 that would likely be fine with continued labor.

Plus, I think these days docs are so much more likely to section at the first little blip that doesn't look right vs. waiting it out. Obviously you'd expect a baby who is only showing minimal signs of distress to come out with decent Apgars vs. one that has no heart rate left by the time they finally get mom to the OR.

I think most OB's way of thinking is more along the lines of 'Why on earth would we let the baby get into THAT much trouble without intervening if the signs were there that baby was in trouble.'

 

[JanetF]

You may have read that 75% in stuff posted on MDC. EFM is a poor tool poorly used and a crap indicator of most things. Check out some of the posts on it for the research I've posted. I loathe the thing...

 

[Lkg4dmcrc]

Thank you. I realize EFM is crap and can give false positives. I guess my question is then, if you had a cesarean for fetal distress (as seen on fetal monitoring internal or external) and your baby had good apgars, does it follow that you had an unnecessary cesarean? Or is it possible to still get fine apgar scores but your baby was actually needing to get out? Do these indicators really tell us enough to know if the baby really needed to get out via surgery or could have tolerated more labor?

 

[witchbaby]

this is purely anecdotal, but i had an "emergency c/s" for "fetal distress" and k came out with 8/9 apgars. a is fairly sure she could have scored a 9/10 but, as my midwife for my pregnancy with m pointed out, they wouldn't give her a higher score even if she deserved it just to cover themselves.
for the record, m had 8/9 after my vbac (my midwife claims she would have given him a 9/10-- we were a hospital transfer).

 

[Finch]

Quote:

Originally Posted by wifeandmom Plus, I think these days docs are so much more likely to section at the first little blip that doesn't look right vs. waiting it out. Obviously you'd expect a baby who is only showing minimal signs of distress to come out with decent Apgars vs. one that has no heart rate left by the time they finally get mom to the OR. I think most OB's way of thinking is more along the lines of 'Why on earth would we let the baby get into THAT much trouble without intervening if the signs were there that baby was in trouble.'

This is exactly what they think. And I can't blame them, quite frankly. They get sued all over the place for things beyond their control. Haven't you all heard how OB's are leaving practice because mal. ins. rates are too high? Why do you think that is?

OB's are scared. They don't want to risk ANYTHING. People sue for everything.