View Full Version : Was this Caeser necessary?
Some of you may have read this before, but I was wondering if I could invoke some discussion.
Here are some labour notes, and I will ask some questions, and I want you to answer by giving the impression you get from them, in your opinion, whether this caeser was necessary:
(also, if you know who's notes these are, please look at them as isolated and make a hypothetical determination based purely on the notes, iykwim.....)
Key: FHR = fetal heart rate
TOS = trial of scar
VE = vaginal examination
CTG = is the continuous fetal monitoring belt/readout
SROM = spontaneous rupture of the membranes
b/m = heart beats per minute
LSCS = lower segment caesarean section
CPD = baby's head and size of pelvis disproportionate (ie, baby too big and/or pelvis too small
Emergency Caesarean
From actual labour notes:
4.55pm
7cm dilated
Book in to hospital
Notes: “FHR 142
Temp 36.9
BP 140/85 P-76
Abdo palp – cephalic, 4/5 palp, ROP?
–C x 7cm dilated pp-3
Bulging forewaters
C+G in progress”
5.30 pm
?
Labour notes: ‘TOS’ ‘head still high’
Ob writes: “Plan – Continuous monitor, repeat VE 3/29 if not pushing, Req a (anethaetist) myself if not progressing in 1st half hour of pushing; watch for any PV blood loss and also FHR pattern”
6.00pm
?
Got into spa bath in labour ward
6.30 pm
?
“Contracting 4:10
FHR 137
Commenced using gas”
7.15pm
?
“Comfortable using Gas, contracting 4:10, CTG satisfactory”
7.25pm
?
SROM
7.45pm
?
Out of bath
8.00pm
7-8 dilated
VE
8.20pm
?
Midwife notes about past hour:
“Taken over care of XXXXX at 19.30 hrs. In spa using Gas at that time. Contracting 3-4(?) strongly. Distressed. SROM at 19.25hrs,clear in the bath at that time. Out of bath at 19.45hrs. VE at 2000 hrs cervix 7-8cms pp-1 copious pink liquor.
Dr B notified of same. CTG reactive + variable baseline 130-140 b/m at that time. At time of report variable decelerations with contractions, XXXXX pushing with contractions and advised to breathe or pant through them. Using gas. Baseline 125-135 b/m”
8.55pm
8-9 dilated
Midwife notes: “Still pushing with contractions, copious pink liquor and bowels opened. VE to assess: cervix 8-9cm thick anteriorly to the right side of cervix pp -1. Posterior fontanelle felt at 1 o’clock. Papation anterior LOA. Currently variable and reactive trace with variable decelerations. Baseline FHR 130-140 b/m. Show present on pad. Contracting 4:10 strongly. Maternal observations within normal limits as charted.”
9.30pm
9cm dilated
VE
9.40pm
Midwife notes: “Dr R M phoned and asked to R/V XXXXX. On VE at 21.30 hrs, cervix 9cm with 8cm thick lip still. Caput present and station -1 to spines. Unable to determine position ? fontanelle felt at 6 o’clock. Contracting 4:10 strong. Copious amounts of clear liquor present and small amount of blood-stained show. XXXXX needing encouragement not to push. Await Dr R M R/V
10.00 pm
8-9 dilated
Dr R M’s notes: “O/E vitals stable, Distressed at pains, Biggish babe!, cephalic 2/5 palpable; V/E Cervical rim around, os 8-9cms Vx at -1, Moulding + caput + ? OA, Clear liquors; CTG satisfactory trace, contractions 4 in10.
Pushing since last 1 hrs, not much progressed over last 3hrs. D/W Dr K. Prep for emergency cs. Consent taken. Paeds Reg informed, Anesthetic informed.”
11.30 pm
Ob comments during surgery: “Judging from the size of him, he would have never fit through your pelvis”.
Ob’s notes: “Post LSCS. 9cms and not progressing. Caput 3+, Moulding 2+, OA position. Stil (sp?) 4/5 palpable abdominally (sp?) PDx CPD
In theatre findings confirmed.
LSCS some bleeding from a?g?h? (sp?) – seared (sp?) Single layer closure, HS (sp?) on Saturday”
800 mls blood loss.
Weight: 4.23 kg
Head Circ: 34 cms
Apgars: 9 at 1 min, 9 at 5 mins
2.30am
Nurses notes: “Returned to ward on trolley with wardsmen & recovery staff at 0130 after an emergency lower segment caesarean section for CPD. S/B Dr M for review of IV fluids. Currently running 1L Hartmanns + 40 units of Synto (line A)& commenced 1L Hartmanns (Line B) over 3/24 ms (sp?) for adequate hydration. Tolerating clear fluids IDC patent and draining dark brown stained urine.
Pain relief as charted.
PV loss small rubra. P+ washed on return to ward. Abdominal wound intact. Nil ooze. Observations T38degrees, BP 138/70, P72, R20. Warm blankets removed.
Baby brought to mum for breastfeed. Sucked well & mum now settled.
1/24 Resp/sedation score continues as ordered.”
NEXT DAY
2.25pm
Obs notes: “C/s for CPD”
Okay.
Questions....
Do you think this caesarean was a life-saving operation in this case?
Do you think this caesarean was necessary?I will also post a poll with this....
Shanaynay
22-04-2007, 04:19
That was interesting to read :yes:
I've never read medical records though so I didn't understand a lot of it. Also I have no idea waht heartbeats etc... are suppossed to be.
But seems to me, that no, this was not a life-saving procedure.
1. Bub was born with Apgars of 9 - so unlikely to have been distressed.
2. Only mention of mum in distress is "distressed at pains". But who isn't by that stage? Also says her vitals are stable.
So seems that at the time the c-section was done, neither mum or bub were distressed.
Doesn't describe any other physical occurances that oculd signal things going wrong such as heavy blood loss, or meconium stained waters etc...
Was it neccesarry?
Well looks like she progressed pretty slowly for a bit there. But the head was still high, so obviously not bearing down on the cervix to help it dilate. Also seems contrax were still pretty far apart then anyway - did it mean one very 3/4 minutes?
Probably was high becuase of the posterior position they later found bub to be in.
So head not really in the best position to help the cervix dilate - which is probably why that lip remained.
Did they not suggest to her to get on her hands and knes, or do some squatting to get bub's head right down there?
Then even if a cervical lip remained then, maybe it could have been manually pushed back.
She was feeling the urge to push, so contrax must have been doing their job, bub just was not in the right place.
As I said, no idea what a lot of it means, but perhaps if they'd tried to get bub into an optimal position, she could have pushed bub out.
But maybe not - maybe no amount of squatting etc... would have changed bub's position.
Maybe she just needed an extra half hour so bub could get rady for that final descent.
Sadly she'll never know :thumbsdown:
eta- just saw poll, i voted option 3
Thanks for your interpretation Phineas :thumbsup:
I would welcome votes from anyone else also, even if you dont want to make a comment.....:yes:
Pippi Longstocking
22-04-2007, 06:49
Sounds to me like failure to wait rather than failure to progress.
I don't understand the part about heart rates etc either but if mum and bub were both doing ok, the surgery was unnecessary.
It sounds a bit like my labours in that I progress very very slowly right up until the point that I don't anymore :p
I always get stuck on 1 and a half to two centimetres for literally hours and sometimes days. But the body is an amazing thing and knows what it's doing! My body always got it in the end and gets it bloody quickly too - with my first, I went from one and a half centimetres (after 20 hours hard labouring) to her being born 36 minutes later.
Oh yeah, thread not about me :o :p
I voted opt 3.
No way was it nessesary! Could have been avoided with better guidance (and protection) from a better midwife :yes:
I'm interested in the notes it says "single layer closure". I wonder why this was the case? Double layer closure are better/stronger aren't they :confused:
Has anyone ever sued for a c/s?
Not being a health professional, I'm not 100% sure, but looks like option 3 to me.
Thanks for this...was very interesting reading!
Nats...your avatar is SCARY!! :eek: :laughing:
MrsTwith3
22-04-2007, 08:56
I also voted for 3. From reading the notes it looks to me like they (Ob and midwives) had differing opinions on what was going on for starters. The mother was going with the flow of things and what her body was telling her to do. The Ob timetabled the mother by not giving her adequate time to get that last centimetre dilated. There was no sign of fetal distress going by the heart rates noted. The pain that was noted by the mother was probably very normal at that stage in labouring.
The Ob noted that at 10pm that the trace was satisfactory so therefore there was no fetal distress apparent or any meconium staining of the liquor which would be another sign of fetal distress.
Hmmm I believe this poor woman definately had an unnecessary c/s.
The post op notes showed that the mother was dehydrated by the dark coloured urine found in the IDC.
So after my ramblings and to answer your 2 questions. No the c/s was not a life saving procedure nor do I think it was necessary.
Thank you for all your responses.....very interesting how you are all interpreting it, as you share my suspicion.
If anyone has voted differently, I would be interested, only if you feel comfortable, to hear your interpretation too.....:yes:
I just wanted to mention that the baby was a pretty decent size. 4.23kgs, my bubs was 4.125kg (9.1pd) and i needed a ventouse to help get him out.
Maybe your pelvis was too small for baby to come out, or they didn't help the baby into the right position like the others have said.
Definately wasn't life-saving by the sounds of it, baby wasn't in distress and neither was mum.
I didn't vote though cause i can see both points.
mamabearof3
22-04-2007, 10:08
There is some research suggesting that true CPD is a fallacy. Positional work can often open the pelvis further, I think I recall another 12%.
Anyway it looks like she was pushing against an incompletely dilated cervix which would have of course caused slower progress with pushing and the swelling of the lip of the cervix. Perhaps if she was encouraged to hands and knees and butt in the air that would take the pressure off the cervix and allow the swelling to dilate also. Or if a midwife felt she could push the swelling out of the way with a contraction as my midwife did with my first babe. Not comfortable but a hell of a lot more comfortable than a caesarean.
Of course my other problem with the notes was the change of shift. Lack of one to one midwifery care is a real problem with labours in my opinion. If the woman had the care of a midwife she knew from early inthe pregnancy and trusted then she may have participated in the decision making more. Sadly the Dr even pre-empted things and the midwives comment of "biggish baby" I find quite rude to place doubt and question in the mother's mind too. If the woman was told the baby was a perfect size for her to birth she may have progressed differently also.
I'd be suggesting this woman get hold of "The Pink Kit" for her next birthing and have one to one midwifery care to improve her outcomes of VBAC.
Not being a dr or nurse, I guess its a hard thing to say, but my labour 2 weeks ago left me with a lip that wasnt budging, and the nurse told me the dr gave me one more hour before we have to do "something" I assumed this was a c-section, however, I did have mecconium, which this lady didnt.
However for me, a shot of pethidine relaxed me enough to move the lip, and for bub to move down, so from that I am going to say that they could have waited longer.
SassyMummy
22-04-2007, 11:05
I think things could have been done to avoid it. High Apgar tests in an emergency c-sec would lead me to believe that the baby was fine, and not in distress at all.
Doesn't say how she was positioned (at least I don't think it did?)... so perhaps better positioning could have helped.
Just a side note on positioning... it's not the same I know, but you use similar muscles and it's pushing all the same... I've seen my DD poo. From here on in, it might be TMI about DD pooing... so read at your own risk... Like, seen it exit her body. When she lays down to do it (I saw this when changing her nappy prematurely), she pushed for ages, and it came out very slowly and very thinly... like her bottom wouldn't open up enough and she had to push extra hard.
I've also seen her poo standing up (she likes ot take her nappy off and do it in a corner somewhere on occassion...gross). When she's squatting doing it, it comes out a lot quicker, and a lot bigger/thicker.
I know that's gross, but surely birthing would be similar. I think there's a reason women in poorer countries squat to give birth, and why we would instinctively squat to do a poo (if we didn't have toilets).
I also don't believe in CPD. I'm sure in a few rare instances it's the case, but it seems it's a reason so many women are given and it's ridiculous. You bub might be too big to enter vaginally if you're laying down, but if you waited a bit, positioned yourself better... you could widen your chances of a VB for sure.
DP's mother is small... prob a size 10. She's not got large hips or anything like that... and she pushed him out when he was 1 month prem... and weighing in at 12lbs. He was MASSIVE.
stellarella
22-04-2007, 11:11
I know whose notes these are :p
I am not an OB or Midwife so some of this is mumbo jumbo to me...but from what i can tell the baby was in no distress, is that right??
Do you think this caesarean was a life-saving operation in this case?I would have to say no...at the time it does not appear that the baby or mother were in danger.
Do you think this caesarean was necessary?At the time no, I couldnt say what would have happened, but there doesnt appear to be any indication for a c/sec, as neither mother or baby were in any danger.
Ana Gram
22-04-2007, 12:49
Probably not. The blood loss would be a bit of a worry for me, but I am a bleeder.
MrsMiggins
22-04-2007, 13:30
What I get from it is that if the mother was in visable distress, then it is possible there may have been justification for the c/s.
It all depends on what (if any) consultation there was with the mother/partner.
If the mother was in distress and felt unable to continue, the medical person/s present may have offered a c/s as an option if they also felt things were not progressing. The thing about the whole failure to progress/failure to wait argument, is that in some cases, the mother may be well & truly over it & may just want a c/s because they can no longer go on. If a c/s was offered & the mother consented because she wanted to, then I feel it was justified.
If on the other hand, the mother felt fine to continue, but was told she needed to have a c/s then it is perhaps a little dubious.
In the OB's initial notes, I see it was written in the plan to request an anaesthetist if no progress after half an hour of pushing, whereas no mention (in these notes) was made of referral to emergency c/s until pushing for 1 hour. That makes it seem as though they were waiting longer than they initially were prepared to wait.
Judging from the FHR, the baby did not appear to be in any distress. (Although were there any heart rates taken after 8.55pm??) The only thing that could possibly indicate foetal distress would be this note here;
"At time of report variable decelerations with contractions..." Based on my own experience of FHR being used to evaluate foetal distress, it would depend largely on when exactly the baby's heart rate dropped in relation to the contraction. If it dropped before the contraction, that could well be an indicator of distress, whereas dropping slightly in response to a contraction is generally considered normal & no cause for concern.
I guess in all, if the mother did not want the c/s, then it was probably not medically necessary. If the mother at the time did want the c/s, then I think there was justification for it.
Hmm I don't think it was a life saving c section at all.
The baby wasn't in great distress after she had been pushing for 3 hours. She was fully dilated wasn't she? She could have been almost there, ready to have a VB........ I dont understand.......
Why would they do a c section just because she was pushing for 3 hours with no progress? is there a time limit or something???
I had a c section so i dont have a clue when it comes to VB's....it just seems odd to me to just say 'ok lets do a c section, she hasnt made progress'' if the baby wasnt in any great deal of stress.
I would be interested to find out whether the mum actualy wanted this c section after hours of pushing or whether she thought she could have carried on.
The mother didnt want a c/sec, and had planned a vb very carefully. She was disappointed by the outcome.
There most certianly is a time limit at most hospitals. Usually 2 hours is the limit,(ridiculous hospy policy, especially if there is no discernible distress to mother or baby) but some women (like me) have much longer pushing stages, and birth just fine.
The key is to get yourself out of an environment where your labour is imposed into a strict timeline, and I chose to homebirth for that very reason, among others.
Duchessa
22-04-2007, 15:13
It reads like failure to wait to me too. I'm no midwife, but it looked like a vag birth was imminent. And it wasn't a huge baby at all. What a stupid thing for the ob to say to the birthing woman "never fit through your pelvis"!
Shanaynay
22-04-2007, 15:17
Oh and 34cm head isn't huge is it?
My pushing stage was 1hr and 50mins with my VBAC.
With the bleeding, it may gave been the csec that caused the large amount bleeding anyhow... I'm a bit of a bleeder too - with my csec I lost 1.5 litres, with my VBAC I lost 1 litre.
Ana Gram
22-04-2007, 15:24
With the bleeding, it may gave been the csec that caused the large amount bleeding anyhow... I'm a bit of a bleeder too - with my csec I lost 1.5 litres, with my VBAC I lost 1 litre.
True, didn't think of that. I lost over a litre with VB and they were getting a bit nervous as was I.
Milliner
22-04-2007, 15:28
I wouldn't say that it was a life saving c-sect. I picked number 3.
MummyCharmzy
22-04-2007, 16:06
doesnt sound like it was necessary to me
stellarella
22-04-2007, 16:16
34cm head seems pretty average to me....DS was 37cm....although it does depend on the womans pelvis...
I am pretty sure this woman went on to birth a bigger baby? Is that correct??
Very interesting Becca... I also voted option 3.
In fact it sounds very similar to my birth, almost to the letter.... though I never read my notes....
From what I gather with the right advice things could have turned out very differently..... there seemed to be no real distress and even though bubs was assessed on several occassions to be posterior... no one seems to have advised her on adopting any positions to help him turn... :rolleyes: Same thing happened to me....
I think the claim of CPD is a bit over the top... seems like the doc trying to justify use of c/s rather than admitting he was impatient and wouldn't wait for the birth to run its course naturally....
danielle13
22-04-2007, 18:24
I voted number 3 too.
I've read these notes before, and the last time I read them I got to the note that the c/s was coming, and I thought "what the *****?? They're doing a c/s - why??"
Alot of this is very similar to my experience, though mine had alot more ups and downs. And I still think mine was unnecessary.
Definitely a case of failure to wait, and sadly, failure to help the mother in any way that would assist in her getting bub into a better position for birth.
So sad.
harvey123
22-04-2007, 18:39
i picked number three bit i wouldn't put the blame (if you call it that) on the women. i think most of us do what we are told because we think medical professionals are following our best interests. going thru a c/s when the power of birth has been taken away from you is a hard and traumatic experience that few understand. the most important thing is to know that all mums (i think so anyway) do the best given the info at the time...labour's certainly not your most rational point in your life. i ended up with an "elective" c/s, mine was necessary i didn't come close to a normal birth. i think birth's not necesarily a purely scientific experience.....there also has to be a going with instinct. our bubs' birth could have been put down to a failure to wait...at 41wks i was cm dilated and with no signs of labour and had started to bleed, my obs was happy to wait until 42wks although fetal monitoring showed that things weren't looking too great. i felt something was wrong and took the c/s path. it turned out the umbilical cord was between my pelvis and dd's head so she would never have been born naturally and if i had of waited things could have turned out very differently. sorry to ramble, but i think the biggest learning out of your example is to trust how you feel and have faith in your body to know what's happening.
~Emmylou~
22-04-2007, 20:30
Ahhh dear...another c/section because of an impatient OB :mad:
No I don't think it was necessary - everything looked to be going along well. Dilation was coming along, baby wasn't distressed, mum was coping well. I would agree with an earlier post that there was a cervical lip happening that probably got more swollen from pushing a bit early but other than that....I really can't see why this c/section was done at all.
Can't see anything in that report that would stand up as evidence of CPD either.
Well, I am sure a lot of you probably already guessed who's notes they are....and it scares me that my labour with DS3 was so obviously badly handled, as you've all commented as such, and the decision to give me a c/sec was such weak pathetic one, and so obviously unnecessary......
As you know I have since gone on to birth my biggest babba, (biggest head circ) at home without a hitch. I also got the cervical lip with DS4, but there was never any talk of needing a c/sec. My midwife just knew what to do with me, peacefully, calmly and professionally, and all was normal and straightforward. I'm sure a lot of you have already my table of comparisons of care linked in my sig below.
So why couldnt a hospital provide this professional care for me, like my IMW had?
Why do so many women go through identical labours like the ones in my notes I've shared, and they come away thinking their surgery was necessary?
Why the f*#@ did they give me a dangerous single layer suture?
Why are they allowed to get away with it????
If I'd had a lung, kidney or something removed 'just in case', I could sue. But if it is a baby being removed unnecessarily, then suddenly it's not a big deal.
My notes are pretty typical of a lot of women's c/sec experiences.....if that doesnt stink of patriarchal patronising dominance over women, I dont know what does!
We have to wake up and smell the coffee......
ps, also, just wanted to add a huge thank you for your interpretations! :hugs:
My notes are pretty typical of a lot of women's c/sec experiences.....if that doesnt stink of patriarchal patronising dominance over women, I dont know what does!
The Ob who sent me to theatre was a woman. I think in her mind she was being thoughtful and sympathetic, saving me and my baby from a dangerous forceps delivery.
I, somehow, don't think they read bubhub :laughing: or they might get an idea about the sacredness of the experience of birth! Oh wait, I read bubhub and I still went to birth crying for drugs.
I think the media has a bit to answer for Bec. I didn't even know that woman gave birth in any other possy that flat on their backs. And I only found that out at the ante-natal class at 28 weeks gestation :o
Yes, you could well be right. The art of birth is lost :(
Hopefully those old dinosaurs with their knives will die out before the next generation of birthing women get infected with this inane medicalisation of childbirth.
Shanaynay
23-04-2007, 22:35
Well said nats :thumbsup:
And wtf is that thing in your avatar? :eek:
Becca, I didn't know these were your notes - I've read your stories tho, that's how I knew a cervical lip could be pushed back :thumbsup:
thanks girls....
I'd still be interested in the interpretation from those who thought the c/sec necessary? (even if you have changed your mind since reading my post to say the notes were mine)...
I do seek a kind of 'necessity' in what I went through, that 'necessity' being a warning, or something, to other women that unneccessary surgery is common, and to be wary and alert and self-protective.
If I'd have wanted a c/sec, I could have just asked for an elective, as my history contains a c/sec. but I didnt want one, and was given one against my wishes.
What I went through is not unique or unusual. It is as common as much as it is probably happening daily, 365 days a year, to women even here in Australia, that they are being lied to, mismanaged and unsupported in birth.
The WHO reccomends a c/sec rate of 10-15%. If the Aussie c/sec rate is something like 25-30%, then it goes to show that half of all c/secs are in the same category as mine.
Shanaynay
24-04-2007, 05:59
The WHO reccomends a c/sec rate of 10-15%.
Wow TBH I even find that suprising.... that's quite a high rate.
Are they saying 10-15% need that csec to save their lives.... or 10-15% would be a bit better off with that csec do you think..... or are they just saying that's a decent rate?
I wonder what the rate is of women that need life saving csecs really is......... birth is a natural process so you'd think it would be quite low... as in 1-2% or something? Which obviously is still quite alot - that means without csecs, one or two women or babies in every hundred giving birth would die....but does anyone knnow if there is an estimate of the rate?
Do I even make sense... I know what I mean, but I don't think it's clear...
What I went through is not unique or unusual. It is as common as much as it is probably happening daily, 365 days a year, to women even here in Australia, that they are being lied to, mismanaged and unsupported in birth.
Totally agreed.... and thus my motivation to finally get off my butt and become someone who can hopefully change it from the inside out... will be a slow process but if I can enhance the birth experience for one woman I'll have acheived something!!
I don't think I've ever felt so unsupported in my life as when I had my little girl... and thats saying something.... just a word for all you out there, chose your birth support persons wisely.... I had my mum and two sisters with me, and if I had to make the choice again I would've been better off on my own... trust your instincts, and if you don't like the middy assigned to you, see if you can do something about it!!
Ana Gram
24-04-2007, 12:14
Wow TBH I even find that suprising.... that's quite a high rate.
Are they saying 10-15% need that csec to save their lives.... or 10-15% would be a bit better off with that csec do you think..... or are they just saying that's a decent rate?
I wonder what the rate is of women that need life saving csecs really is......... birth is a natural process so you'd think it would be quite low... as in 1-2% or something? Which obviously is still quite alot - that means without csecs, one or two women or babies in every hundred giving birth would die....but does anyone knnow if there is an estimate of the rate?
Do I even make sense... I know what I mean, but I don't think it's clear...
Perhaps they are taking into account c-sections that wouldn't be considered life saving but births that still do excessive damage to the mother?
MrsMiggins
24-04-2007, 13:03
thanks girls....
I'd still be interested in the interpretation from those who thought the c/sec necessary? (even if you have changed your mind since reading my post to say the notes were mine)...
I do seek a kind of 'necessity' in what I went through, that 'necessity' being a warning, or something, to other women that unneccessary surgery is common, and to be wary and alert and self-protective.
If I'd have wanted a c/sec, I could have just asked for an elective, as my history contains a c/sec. but I didnt want one, and was given one against my wishes.
What I went through is not unique or unusual. It is as common as much as it is probably happening daily, 365 days a year, to women even here in Australia, that they are being lied to, mismanaged and unsupported in birth.
The WHO reccomends a c/sec rate of 10-15%. If the Aussie c/sec rate is something like 25-30%, then it goes to show that half of all c/secs are in the same category as mine.
becca, I'm just curious as to what went on when they offered you the c/s.
According to the notes you posted, it says you consented to the c/s (which I totally understand may have been under misinformation or duress) but I think it is important info if you're asking for opinions on whether or not the c/s was necessary.
I know I stated this previously, but if they suggested a c/s on the basis that you appeared overly distressed and you accepted, then I honestly could not say the medical professionals involved in your care could be held responsible.
If on the other hand, they deliberately misled or misinformed you as to the well being of yourself and/or your baby and used this to frighten you into having a c/s, then of course that is another matter entirely.
My opinion is very much that medical professionals are not there to misinform and bully patients into having unnecessary and intrusive medical procedures. Contrary to popular belief, it is not in their best interests to do so. I think instead, that they tend to err on the side of caution, purely to protect the mother and/or baby (in the case of obstetrics). If there is cause for concern, they often are forced to see it as a worse case scenario. If they don't & something terrible does happen, they leave themselves open to all sorts of litigation. Unfortunately the other side of that means there will always be cases such as yours.
An unenviable position for medical professionals to be in. I know if I were in that same position, I would err on the side of knowing mum & bub can both go home safely.
Shanaynay
24-04-2007, 14:20
Perhaps they are taking into account c-sections that wouldn't be considered life saving but births that still do excessive damage to the mother?
Hmmm.... one in ten sounds like a reasonable figure then, I think.... although that's rather scary.... seeing as birth should be a normal process, for such a large proportion to come away from it with a fair bit of damage :thumbsdown:
Hard to judge tho, which births are going to do too much damage, before it actually happens sometimes :thumbsdown:
I voted for option 3.
I think the c/sect could have been avoided for sure! Baby was in no sign of distress, mum was not either.
Baby could have been encouraged by a walk around the ward, mum being on all fours to open her pelvis more. Bub really was not that big... 4.23kgs... my last was 4.13 and I am not a big person (anyone who's met me can vouch for that!) and I birthed her fine! HC was 34cm too.
Mum was pushing way too soon, at 8 cm should not be pushing.
I feel if left a while longer the labour may have progressed and she may very well have been able to birth vaginally.
To me seemed like the DR was the one in the hurry.
IMO, they should have left her to labour longer... telling her not to push, but walk around, rock her pelvis etc etc.
ETA, didn't realise these were YOUR notes... I only read the op.
But my opinion remains the same.
becca, I'm just curious as to what went on when they offered you the c/s.
According to the notes you posted, it says you consented to the c/s (which I totally understand may have been under misinformation or duress) but I think it is important info if you're asking for opinions on whether or not the c/s was necessary.
I know I stated this previously, but if they suggested a c/s on the basis that you appeared overly distressed and you accepted, then I honestly could not say the medical professionals involved in your care could be held responsible.
If on the other hand, they deliberately misled or misinformed you as to the well being of yourself and/or your baby and used this to frighten you into having a c/s, then of course that is another matter entirely.
My opinion is very much that medical professionals are not there to misinform and bully patients into having unnecessary and intrusive medical procedures. Contrary to popular belief, it is not in their best interests to do so. I think instead, that they tend to err on the side of caution, purely to protect the mother and/or baby (in the case of obstetrics). If there is cause for concern, they often are forced to see it as a worse case scenario. If they don't & something terrible does happen, they leave themselves open to all sorts of litigation. Unfortunately the other side of that means there will always be cases such as yours.
An unenviable position for medical professionals to be in. I know if I were in that same position, I would err on the side of knowing mum & bub can both go home safely.
I dont agree with you that that knOb had a hard decision to make. He had decided to section me from the beginning. He just wanted to prove the stupid woman wrong. He wanted to let me labour till the last minute and take advantage of my labourland state to coerce me into birth rape.
Strong words I know. But I did NOT want that c/sec. I did not NEED that c/sec (DS4s birth proves this). He was just a totaly w@nker. Him and his sidekick medwife.
When you read my birth story (linked in my sig) you can see what went on.
I dont remember signing anything, in fact, I distinctly remember hearing echos with the word caesarean being said, and I couldnt work out whether they meant I might need one or I did need one. I asked DH, and he said that they wanted me to have one. I thought I had no choice in the matter. I had no idea why they wanted to section me, as I was very deep in labourland. Next thing I know, the epidural man is there, and I was extremely upset at them telling me I needed a c/section, and I remember shouting and swearing at him that 'if I didnt have a choice then he should f'ing just get on with sorting it out'. I was wildly angry, I was swearing on the top of my voice, going on at them at how useless they were, how they were idiots because they didnt know how to help me. I distinctly remember swearing at the medwife and saying "Ina May Gaskin would f'ing know what to do to help, why the f dont you know how to help me, you are useless, you are a stupid excuse for a midwife...yadayadayada...." I was being highly abusive, but hey, they were pulling the plug on my labour whilst I was in transition.
This brings a lot of anger out in me as I type. (not at you or anyone here on bubhub, just towards the hospy and the way they treated me).
I wasnt wrong about them being utterly useless. My labour with DS4 was IDENTICAL to DS3's labour. WHY were the hospital inferior to my homebirth midwife? WHY were they totally useless????
2 identical labours. 2 radically different outcomes.
Maybe I dont suit hospital birth, and never did? I should have opted for homebirth with my 1st son, and none of this disaster would have happened? I didnt even have gas at my homebirth, so was more acutely aware of how the contractions felt, yet I felt secure, safe, protected.....my MW and DH had faith in me, they trusted me to give birth.
That is the difference.
It is like someone trying to run in a marathon.
If everyone on the sidelines is trying to tell you you are going to fail, you look tired, you arent going to make it, why dont you just give up....what do you think the result is going to be?
On the other hand, if the crowd on the sidelines are cheering you on, they have faith in you, they are telling you you are doing well, and that you are going to make it because they believe you are capable, what do you think the result will be?
I was like the first marathon runner. Noone believed in me. I was doomed. They had no intention of letting me have a vb. As you can see, upon booking in, the knOB was only going to give me 30 mins of pushing time before phoning the epi-man.
I think I'm going to go off and take some emergency bush essence now......:gloomy:
Shanaynay
24-04-2007, 18:21
...Becca :crying:
I'm sorry for getting passionate....but Oskar's extraction is a hard issue for me to deal with, but my determination to make something right come out of something that went so badly, to give honour and meaning to the day my precious son entered the world, is stronger than the pain of my trauma.
I am doing it for him, and for other mothers and babies who should not have to be coerced the way I was.
If anyone is interested, you can see the summary of the original birth plan I wrote up (the actual birth plan was several pages long, so I wrote a summary to give to the hospital, and if they had any questions they could refer to the actual one). The Ob notes that he 'sighted' it. He didnt read it. He didnt care about it. He saw it existed, poo-pooed it, and went on to humiliate me.
you can view it here: http://blog.myspace.com/index.cfm?fuseaction=blog.view&friendID=107603514&blogID=257052124&MyToken=1af810d3-cf2e-4884-84c3-3f32d9a77174 and (http://blog.myspace.com/index.cfm?fuseaction=blog.view&friendID=107603514&blogID=257052124&MyToken=1af810d3-cf2e-4884-84c3-3f32d9a77174 and) you can also see what I wrote on the back of that actual birth plan the day after the surgery. I was not a happy camper :no:.
It is as plain as day, they did not give me the caeser to save my life. They did not give me the caeser to err on the side of caution.
I am currently pursuing answers from the hospital who did this to me.
Duchessa
24-04-2007, 20:14
Don't you apologise for getting passionate, Becca - how could your experience and your quest for knowledge not result in passion! If 1/2 of us had a 1/4 of your passion, the rest of us would have real birth choices.
You are a remarkably brave and introspective woman and I respect you greatly for being able to discuss your birth so openly and without shame. You have taught me and I am sure MANY women so much from your experiences.
Your anger is so justified and your point
If I'd had a lung, kidney or something removed 'just in case', I could sue. But if it is a baby being removed unnecessarily, then suddenly it's not a big deal. is so valid.
:hugs:
stellarella
24-04-2007, 20:54
I admire you too becca and I find you very inspirational...I am sorry you and oskar had to go through what you did to make you become this amazing and strong woman but you have helped so many people already, including me.
I read all your birth stories the other day, thanks for always being so honest about your experiences. :hugs:
Don't you apologise for getting passionate, Becca - how could your experience and your quest for knowledge not result in passion! If 1/2 of us had a 1/4 of your passion, the rest of us would have real birth choices.
You are a remarkably brave and introspective woman and I respect you greatly for being able to discuss your birth so openly and without shame. You have taught me and I am sure MANY women so much from your experiences.
Your anger is so justified and your point is so valid.
:hugs:
I couldn't agree more. You have been such a support to me and many other women. We are very lucky to have you here.:hugs:
Thank you to all you beautiful women...this is an overwhelming yet necessary part of my journey.
I talked with DH tonight, he too remembers assuming that, at the time, there must have been some life threatening reason as to why the Ob suggested a c/sec....he also agrees that in retrospect we know better now.
It's a hard road, but I pray for a day when women are able to reclaim birth as their own, and I hope what i have been through is part of that reclaiming process....
much love to you all, your words have filled me up with such comfort and strength x
:hugs: :hugs: Becca..You are so inspirational and passionate...don't go changing! ;) And never, never apologise for your passion!! :thumbsup:
allysophia
25-04-2007, 08:25
How terrible! My heart truly goes out to you. Birth is a beautiful, amazing and empowering experience, which no woman should be denied!
:hugs:
I really feel for you, and I hope that this helps your grieving process.
(those b#stards, I think you should sue, or at least write a firmly worded letter)
:hugs: Becca, your words bring tears to my eyes. It's injustice!
You are an amazing strong woman and I thank you :yes: you mean alot to alot of people. :hugs:
Keep us up to date.
YummyMummy1
25-04-2007, 21:47
:shame: I thought you only started pushing when you were 10cm ? i have had three natural labours. i hate doctors !! only midwife for me! doctors are so quick to cut or snip or anything they can do to interfere with mother nature.!
but this woman could have said no :thumbsdown: to a c-section in the end it is your body. but also its very hard to make a decision when your in labour you tend to put a lot of trust into your partner and midwife. i will vote number 3
using different positions work very well,
:angel: i had my first on my back (yuk, very bad! never do it again!) second on my knees over a ball in shower (very good!)did'nt have to push much, third time on a birthing seat in the shower (the best!!!) did'nt even have to push! he just slid out, well nearly. i'm 162cm tall and weigh aprox 50kg and my baby's have been about 7 pounds a good size for someone so small like myself. Anyway its not the weight of the baby its the size of the head that counts!:yes:
I wish to express a view different to most other posters'. This is my personal opinion only based on what's posted by becca, so please don't flame me.
It appeared that the pregress of labour had been 1-2cm after 5hours, from 4:55pm to 10pm. There was also significant caput and moulding on the baby's head, which would indicate that the contractions were strong. The baby's position was OA, thus there was no malposition. Therefore the most likely cause of poor progress is CPD, in the case a relative CPD as Becca had since had a VB. I am not sure how long the labour had been going for before preseting to the hospital, but a prolonged labour with secondary arrest in a scarred uterus would significantly increase the chance of uterine rupture, thus I feel that a C/S is indicated in this stage.
As to whether it is life saving, probably not, though from the notes written that didn't seem to be the indication anywhere. To say that it is definitely life-saving or not, then you need a retroscope. No one can predict what will happen if a C/S was not done at that time. Prolonged or obstructed labour can greatly increase the risk of infection to the mother and baby, post-partum haemorrhage resulting in surgery, hysterectomy, ICU admission, death, fetal distress and compromise etc. Whether a c/s should be done at certain point depends on what risk is acceptable to the woman. If 50 c/s need to be done to prevent a bad outcome is that acceptable? How about 10, or 100? Where do you draw the line? It is not practical to say that " I don't want a C/S or instrumrntal delivery or whatever unless it is absolutely necessary" How do you define absolutely necessary and how do you predict when it is absolutely necessary. Some posters had worded their comments very strongly against the care provider, which would seem unfair, unless Becca did not consent to the surgery. Ultimately it is the woman's decision, as it is her body and her baby, the care providers are only there to give advice/recommendation.
No one can predict what will happen if a C/S was not done at that time.
But..........That retroscope exists!
My labour with DS4 was identical, yet resulted in a normal vaginal birth, and he had a bigger head circ, as well as being heavier. i have both labour notes side by side in a table.
You can view it here:
http://blog.myspace.com/index.cfm?fuseaction=blog.view&friendID=107603514&blogID=203100841&MyToken=180ac310-7e77-4c2f-8a15-e4d9da9cf339
My 2nd c/sec was unnecessary. I refuse to be butchered and face increased risks to me and bubs from a c/sec, just so some Ob can keep his kids in private school :no: . If he can't take the heat, get out of the kitchen :rolleyes: .
ps. i dont have any recollection of giving consent. neither does my husband.
:shame: I thought you only started pushing when you were 10cm ? i have had three natural labours. i hate doctors !! only midwife for me! doctors are so quick to cut or snip or anything they can do to interfere with mother nature.!
but this woman could have said no :thumbsdown: to a c-section in the end it is your body. but also its very hard to make a decision when your in labour you tend to put a lot of trust into your partner and midwife. i will vote number 3
using different positions work very well,
:angel: i had my first on my back (yuk, very bad! never do it again!) second on my knees over a ball in shower (very good!)did'nt have to push much, third time on a birthing seat in the shower (the best!!!) did'nt even have to push! he just slid out, well nearly. i'm 162cm tall and weigh aprox 50kg and my baby's have been about 7 pounds a good size for someone so small like myself. Anyway its not the weight of the baby its the size of the head that counts!:yes:
I wasnt given the opportunity to say no, as they told me the c/sec was needed. You are right about being unable to make coherent choices in the midst of labourland. They took advantage of me whilst I was in that state.
You are welcome to read my birth stories and comparison between the labour notes in my OP and my subsequent homebirth last year, you can click for both of these in my sig.
The cascade of errors I made which led to the disaster:
1. I didnt demand a homebirth. I should have followed my instincts, been more assertive.
2. I didnt demand a doula. I should have followed my instincts, been more assertive.
3. Allowing myself to submit to the CTG. I should have been more assertive.
4. Allowing predators into my birth space, which caused the 'fight or flight' syndrome to take a hold of my body and hold up my labour. Before that OB burst in uninvited, my contractions felt as though I was a dolphin dipping in and out of waves. After he came in, I started getting the hallucinations which haunt me to this day. To the primitive/instinctive birthing part of my brain, I interpreted him as a predator.
5. Giving up and using gas....this was because the 'fight or flight' syndrome had kicked in. I was scared. I was fighting.
6. Choosing birth care-providers who had inferior knowledge about birth and had NO knowledge about simple remedies. Why couldnt they do what my IMW did for me during DS4's birth?? Were they that stupid??? Yes they were, they were imbiciles.
As you can see from the above, I admit my part in the disaster. Why cant they admit their part? I just want to hear an apology from them. An admission that they got it wrong. And my prayer is that they learn from it, and not do it to other women in my position.
I've tasted the truth about birth, and I cannot stand by silent watching other women led like lambs to the slaughter. I just can't :no: .
I refuse to be butchered and face increased risks to me and bubs from a c/sec, just so some Ob can keep his kids in private school :no:
I assume you meant they get paid more from a C/S? That's actually not true as the fee for VBAC is higher than a C/S. Although from your notes it seems like you were a public patient? If so then it would have been in their best financial interest to push for a VB, rather than a C/S as VB is cheaper for the hospital, also less work for the doctors as the midwives would generally be the ones doing the work. So perhaps they didn't do the C/S because of the financial reward? Or to save the doctor time as he/she would not had been required if it was a VB, assuming that this was a public hospital?
What was the hospital's response when you questioned them about your labour/delivery?
I assume you meant they get paid more from a C/S? That's actually not true as the fee for VBAC is higher than a C/S. Although from your notes it seems like you were a public patient? If so then it would have been in their best financial interest to push for a VB, rather than a C/S as VB is cheaper for the hospital, also less work for the doctors as the midwives would generally be the ones doing the work. So perhaps they didn't do the C/S because of the financial reward? Or to save the doctor time as he/she would not had been required if it was a VB, assuming that this was a public hospital?
What was the hospital's response when you questioned them about your labour/delivery?
I am still waiting for a response from the hospital, they responded on 15 March to say they were going to look into it, and am posting a prompting letter today.
My comments re financial gain, was more to do with their fear of litigation. At the time, I'd only had 1 c/sec, and had had a 'TOS', which proved the integrity of my scar during labour. My risks for UR were actually smaller than that of a normal vbac woman, as my scar was proven strong.
So the risk of UR was something like 0.7% or less, I'm sure. To me, a 99.3% chance of NO UR was pretty excellent (considering in the same statistical circumstances, if I had a $million lottery ticket, I was guaranteed a win). I do understand that the Ob was probably worried I could be the 1 in 1000 woman to have a UR, but why do 999 women have to be subjected to surgery, that gives a 3 times more likely chance of maternal death, and makes it twice as likely that my baby would need to go to the NICU.
Surgery isnt always a good outome. It is only a good outcome when it is necessary or wanted (and even then it's not guaranteed). When you interupt a natural process unnecessarily, there is inevitably a severe price to pay. I wonder how many Obs would continue with submitting women like myself to unnecessary surgery if the tables were turned, and we could sue for the trauma and damage that was inflicted upon us for no reason.
The more women I hear about who go through what I did, I am beginning to slowly turn in my heart to believing that legal action might have to be something I take.....
PTSD is not a healthy outcome. I see too many women who get it from bad birth experiences. It is scandalous. Birth doesnt have to be bad. I know. I have tasted it.
lastchance
03-05-2007, 21:44
Becca,
Good on you for posting a really interesting discussion. I think hospitals/medicos try to cover themselves by using the word "emergency" in front of the c/s, to try to scare people into thinking something was really going wrong therefore the operation was needed. there should be 3 categorys: elective c/s, emergency c/s and unplanned c/s which is what yours was.
Because all the unplanned and real emergency c/s are lumped into one big category hospitals will never be able to figure out what phineas (i think it was) was asking. but I think there might be specialist units in some of the state health departments that do analyse the data about births.
I wonder what the rate is of women that need life saving csecs really is......... birth is a natural process so you'd think it would be quite low... as in 1-2% or something? Which obviously is still quite alot - that means without csecs, one or two women or babies in every hundred giving birth would die....but does anyone knnow if there is an estimate of the rate?
Do I even make sense... I know what I mean, but I don't think it's clear...
Also I can really relate to your comment about consenting to the procedure. I has a real emergency c/s (DD's heart rate did not recover after contractions) and I remember being so involved in the whole pain thing that I just thought it was ridiculous them asking me this important question about consent when my brain was not even functioning on that level!!!
Australias rate of c/s is shocking and only women can do something about it.
You are right lastchance, it is up to us women....we really need to reclaim our bodies!
And lots of *postive:wizard: vibes* that we will hear that you have a bubalicious swelling belly and be experiencing a beautiful birth very soon!!
Thank you for sharing your story and notes it was interesting to read. Having not given birth yet myself I wasn't sure either way.
On the one hand health professionals should have the Mum and bub's best interest at heart but the discussion seems to be around at what point should medical intervention occur and why - is it more for the convenience of medical staff these days rather than saving a life??
Did this person have a birth plan, which set out their wishes? I agree with other comments perhaps next time an experienced mid wife or Doula could provide more support and advice during the birth?
Sorry for long post, but good luck with whatever you decide to do.
fai firinne
17-05-2007, 20:00
The notes first said that the baby was posterior, but then they said it was anterior.
The baby was never in distress.
The mother had only been pushing for an hour.
The baby was larger, but I think the Ob's comment that he would "never fit through your pelvis" was a very negative and discouraging pronouncement to make over this woman.
They have said that the "emergency" c/s was for CPD. I don't think that is truthful. I think the problem was more "failure to wait", not "failure to progress" or anything defective about the woman's pelvis.
Continous foetal monitoring was ordered. This reduced her mobility. I wonder if she was upright and mobilising?
Regular VEs were ordered. That also hinders the progress of labour.
It is hard to birth a baby when privacy, mobility, gravity and quiet respectful support are dminished.
These case notes kind of make you think that it was a case of "we did a c/s because we can" rather than because of a genuine emergency.
I think it was a failure to support the woman's birthing potential, not any failure on the part of the woman's body or birthing capabilities.
I am not against necessary c/s and some people elect for c/s for their own reasons. But I feel sad when unnecessary c/s are pressured on women who wanted to avoid them.
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