Posted 01 June 2008 - 10:43 PM
I have just finished reading through this thread and I can see all points, but I have a few things to add. I am an rural nurse, so I do everything from geriatrics, cardiac, emergency, med/surg, labour & delivery and whatever else needs to be done. In our town, c-sections are not done unless absolutely necessary, but we only have a handful of drs that do deliveries (we only have 10 drs most often), one dr that does c-sections and 2 drs that do anestetics, but only one of them does epidurals. If there is a failure to progress, fetal distress or any of the other several medical reasons for a section, the dr that does the c-section is called in to do a consultation. From there the dr makes a decision whether to section or not, and discusses it with the pt. We do have some scheduled c-sections, but they are usually repeat sections or breech presentation. Then there are the emergency sections were the OR staff are called in. Around here we are not given the choice of having an elective c-section without a medical reason. As I say this, I know that this will not be the same in every hospital, town or city.
As for pt's having a natural birth, I have seen many that have planned for that, and even in early stages of labour still plan to do so (although they are usually still smiling too) Like we say, if you are still smiling, you have a ways to go! Not all pt's decide against the natural birth in the end, but many, if not most do. They are asking for something for pain and usually an epidural. Of course in our hospital, only one dr that does them and usually being short staffed with no nurse to special an epidural pt, they often don't get the option of an epidural. There are many other ways of non-medicinal pain control, but you have to find what works for you. As for epidurals slowing down labour, I have seen where it has done so, where it didn't seem to make any difference other than pain relief, and I have seen where it has sped up the delivery because the pt was so tense from the pain.
As for personal experience as a mother, I have had 2 c-sections and the second one was elective, but here is my situation. I had been contracting for a week and a half with leaking membranes. Finally I went into the hospital at 1am with strong contractions every 3 minutes. I was still only 1 cm dialted. At 8 am the dr ruptured my membranes completely, then at 1 pm I was put on the drip. By 5 pm I was still only 5 cm so an epidural was arranged for me. (I did not want an epidural at all, but by this time I was tired and I knew it was going to be a section, so I got it)By 6pm I had the epidural and was out like a light. At 8pm I still hadn't progressed, so I was given the option of waiting for another hour or to go ahead with the section. I choose the section. I had my daughter by section at 9:19pm, 20 hours after getting to the hospital, but a week and a half after starting to contract and living in the bath tub. In the end, my daughters head was engagedin my pelvis wrong and would not have been able to make it out. She was only 6 lbs 8 oz.
Then with my son, I wanted to have a VBAC. I did not want to have another c-section if I didn't have to. I finally gave in and had an elective section which everyone I knew was trying to encourage me to do. The reason everyone wanted me to have section and the reason I gave in was because my pelvis was separated. OUCH!!!! My pelvis was so bad that I had a 4-wheeled walker for the last 2 1/2 months of my pregnancy. I had 2 ambulance trips to the city, just to be sent home the next day, and there was almost a 3rd trip. When they had to rearrange the OR schedule, they left a spot open for me in case I decided to have a c-section. So finally I decided it was time rather than being sent to the city however many more times before having the baby and ending up with a section there. (My dr who can do VBACs was out of town and the OBGYN that comes out here as a specialist said he would deliver my baby, and he was in town for my section) Since I didn't go through the labouring process, my recovery was a lot better the second time around. BUT, I cried for the 4 days between deciding on a section and actually having it. I cried as they preped me before the OR, in the anti-room and even on the OR table, why? because I didn't want a section, but I knew that it was the best choice. With my pelvis in the condition it was, having a VBAC could have caused permanent damage. My son was healthy at 3 weeks early, 7 lbs 6 oz and a head size 4 weeks ahead of his age. I have come to accept that my pelvis is not adaquate for having babies, and when it is time for baby #3, I will probably just have an elective section, although I may still enquire about a VBAC if my pelvis isn't separated again.
In the end, each person, each baby and each delivery is different. As long as the baby is healthy and mom is healthy, that is what is important. To have a c-section or not too......you need to read the FACTS on both. During your pregancy you should be researching them anyways and asking your dr questions. Taking prenatal classes also inform you on these issues. Make sure you go into it with an open mind or you could be very dissapointed in the end. Also, keep in mind that failure to progress is if there is less than 1 cm dilation in a 2 hour period, this is called dystosia.
Is it possible to have a natural birth? YES! It happens a lot, sometimes because that is what the Mom wants, and sometimes because things go too quickly for them to have anything. People should be encouraging, not all birthing stories are aweful experiences.
Dbld78 - I like how you pointed out how so many people are willing to get other surgeries like boob jobs, nose jobs and the like without thinking about the real complications that can result.
C-sections are major ABD surgery, so they shouldn't be taken lightly, and yes I think there is room for a decrease in the c-section rates, but when it comes down to it, it is up to both the pt and the medical experts. After all, both are the cause of the high non-medical section rates.