Monday, May 5, 2008

Crash C-sections

I taught childbirth classes for about a year at the end of my L&D nursing career. Mostly it was groups of couples interested in doing the best for their baby, as long as that didn't entail any bit of discomfort for mom. They were very trusting of their doctor's recommendations.

Class after class, these friendly, smiling couples would come and go. They were excited, eager, full of anticipation. They chatted about baby names and nursery decor. They compared due dates and ankle swelling and lower back aches. It really was a lot of fun meeting all these couples on the verge of such an amazing life change. Mostly we covered "Childbirth Basics" and we never went into any real depth about maternity care management in the US. Of course, I maintained a very professional decorum as a hospital childbirth instructor. I would never have endorsed homebirth and would never have mentioned that I had ever had one myself.

On occasion, I did get the "oddball" couple interested in natural childbirth. They were usually the ones with the most interesting questions about interventions and they also usually asked about ways to avoid a C-section.

One time we were talking about the rising C-section rate and the concern was raised about "dinner time" Caesareans. A father-to-be asked me, "How do you know, if the doctor is recommending a C-section, that it is truly necessary?"

I answered, "If the doctor is sitting at the bedside chatting with you, then you have time to ask questions and discuss the matter and it is totally optional at that point.

However, if the room has suddenly filled up with people in nursing uniforms and the monitors are being removed and the doctor is pushing the bed out of the room and starting down the hallway, then there is no time to talk, the C-section is necessary!"

We went through the usual "Lamaze" type questions to ask when an OB recommends a C-section. "What are the risks of having the surgery? What are the risks of not having the surgery? What are the risk of waiting thirty minutes to decide? " I left my class attendees with the idea that, as long as the doctor was standing at the bedside, taking time to discuss the matter with you, then the C-section "option" is just that: optional!!

Also, I made it very clear that if the baby or mother is truly in imminent danger, NO ONE stands around and discusses it! A C-section that is decided in haste is the really, truly necessary one!


A story comes to mind.....

A first time mommy-to-be was brought in for induction. She was induced with Pitocin, an IV uterine muscle stimulant. She was having really strong, Pitocin induced contractions that were difficult to tolerate, so she decided on an epidural. The mother's BP drastically and suddenly lowered after she had received epidural anesthesia. We call this "bottoming out" and while it's not common, it's also not really that unusual post epidural. Mostly it is prevented by getting a large amount of IV fluids in immediately preceding the administration of the epidural anesthesia. When this mother's BP "bottomed out" her OB happened to be in the room. The baby's heart rate started dropping also. Standard procedure when this happens post epidural is to open of the main IV line "wide open" to give a large amount of IV fluids super fast to counteract the sudden drop in BP. As the baby's heart rate dropped, the MD rushed over to the mother's IV stand and opened up one of her IV fluids to run in "wide open." It was soon discovered that the MD had opened up the mother's Pitocin IV line full blast, causing her body to have a sudden, amazing overdose of this potent uterine stimulant. The mother was rushed for an immediate Crash C-section.


And you know, there are actually a few C-section stories like this buzzing around in my brain, but its late and me and my baby are going to snuggle in bed.


I am a Monkey's Mama said...

Wow. I don't know that there are any words...

Stories like this make me so glad that I have chosen to birth at home this time around.

Thank you for sharing your truth.


pinky said...

Wow. Good explaination of C-section urgency. I think I may use that one myself.

I have never had a crash C-section for post epidural bottoming out.

Doctors need to leave my stuff alone. When the Dr or Midwife messes with my pump, I get pissed.

Wasn't the Pitocin on a pump? Didn't the Doctor see it was on a pump? A good rule of thumb is to not mess with a pump if you are not totally sure what is infusing. What if it was Potassium? What if it was Heparin? Was the Doctor reamed for this one? Was risk management called into this one? Is the baby ok?

Mary the Birth Goddess said...

oh Pinky- you and I live in different worlds! But I can also state, I have never had a crash section immediately after epidural. This "crash" was due to the docs accidental IV blast of Pitocin- not the epidural. I have had at least 2 crash sections for fetal distress that occurred immediately post amniotomy, so they were "intervention" triggered sections.

I am thinking that the Pit was off/pump was off so the doc just grabbed a line and opened it- obviously without looking at the bag to double check its contents. I was not the L&D nurse on this one, I cared for mom post op and became aware of the events that occurred pre-op during report.
of course, I have to be very careful not to reveal any details to protect eveyones identity and not violate HIPPA when I post these stories.

pinky said...

OK. How about a new post? We miss you.

Heidi said...

Riveting blog! Thanks for sharing and caring about women!

TheFeministBreeder said...

That was me. I was that woman.

Induction (for post dates)
Internal Fetal Monitor
More Pitocin
More Epidural
OH MY GOD, heart decels
"You need a C-section"
Me: sobbing
Husband: "You did everything you could."
Wheeled into OR
Don't see my baby for 6 hours


2 years later...

Glorious VBAC to a nearly 10 lb baby boy.
Despite Doctor's insistance that my uterus "won't work."

and next time, a home birth.

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