There seems to be an epidemic of Emergency Cesareans. When I talk with moms, or read birth stories, many label their cesareans as emergency’s. But as I ask questions or as I read details, I see that it wasn’t a true medical emergency, but mom has been led to believe it was. Even my cesarean, which I have always called an emergency cesarean, really was ‘urgent’, not an ’emergency’, the difference being the timing.
Is it just a lack of good definitions for the types of cesareans? I think in many people’s minds it is either a
planned cesarean = non-emergency
or
un-planned = emergency.
I have come up with more descriptive labels. What do you think? Do you have any to add?
Planned Cesareans:
Elective – mother chooses without a medical reason. For example: fear of pain.
Care Provider or Mother Convenience – Sometimes care providers will even suggest a cesarean for convenience for him or the mom.
Medically indicated – mother chooses for a good medical reason. For example: complete placenta previa.
Care Provider Necessitated/Pressured – Some planned cesareans, may have questionable reasons. For example: twins; breech; or suspected big baby.
Her OB says it is medically indicated so mom assumes it is, but if she was to do further research, she would find that she has other options. Many care providers allow twin births, breech births, believe babies grow to the perfect size for the mothers, etc.
Unplanned Cesareans:
Emergency due to natural causes – A life threatening situation to mom or baby. Time from decision to surgery would be less than 10 minutes. For example: placental abruption.
Emergency due to interventions – A life threatening situation to mom or baby. Time from decision to surgery would be less than 10 minutes. For example: Breaking of water causes cord to prolapse.
Urgent due to natural causes – Medically indicated, but not currently life threatening. Typically the time from decision to surgery would be 20-60 minutes. For example: baby is showing distress due to cord issues.
Urgent due to interventions – Medically indicated, but not currently life threatening. Typically the time from decision to surgery would be 20-60 minutes. For example: pitocin induced contractions causing distress to baby
Maternal Choice due to natural causes – For example: mother’s intuition (mother senses something is wrong and upon delivery indeed there is an issue.)
Maternal Choice due to interventions – For example: not allowing food causes mom to feel nauseous and exhausted.
Failure to Progress (or Failure toWait) – progress may be slower than anticipated but mom and baby are doing fine. OB is ready to go home, or hospital has arbitrary “guidelines”. For example: mom can only push 2 hours.
Failed Induction – Your body was not ready to give birth or baby was not ready to be born.
Often the care provider blames it on mom or baby. For example, “Oh this baby was just too big or your pelvis was too small. ” This can be damaging to mom, who may think her body doesn’t “work” Let’s say what it really is, your body and or your baby were not ready. Or more simply the induction did not work.
Reluctant Mother Choice / Nothing Else Seems to be Working – This is for moms who have tried waiting hours, different positions. Mom and baby are still doing fine, but (usually because of baby positioning) no progress is being made and mom is told this is the way baby is coming out. So mom reluctantly goes forward.
Are there any other categories you can think of or would like to suggest? Please leave a comment!
If you have had a cesarean, please do the poll on the type you had!
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Great entry, Sheridan. You’re right, so many women are led to believe it was an emergency simply because it wasn’t planned. What a crock. And I’m sure it leads women to want a c/s for subsequent births just so they can avoid another “emergency.”
I’m wondering how my c/s would be labeled. Abby was asinclytic (totally guessing at the spelling there), so it wouldn’t have mattered how long we waited, she wouldn’t have come. But neither of us was in distress. The OB suggested the c/s because “there’s nothing left for us to do” and “you’re so tired that if things kick in you won’t be able to push.” Of course I’d been at the hospital for about 20 hours with nothing but water and a couple cups of jell-o to eat, and while I was indeed tired I wonder if I’d have perked up with some food. (I’d been napping in between surges, too, so it’s not like I’d been completely without sleep.) So…I guess it could be labeled with both of your maternal choice labels, though I didn’t really *want* to choose it, but I was led to believe it was our only option. (Though I later discovered that a midwife would have approached things in a totally different way and could probably have fixed things, so while it was the OB’s only option, it would not have been a midwife’s.) Hm.
I was horrified watching t.v. the other day about Twins. Now I wasn’t watching a birth story but rather about whether or not identical twins are genetically identical. as it turns out..no they’re not.
anyway.. a mother of twins was scheduled as the show called “full term for twins” a ghastly 35 weeks!!! for a planned c-section. The reason being… she was having twins. that was it. it made no further medical indication, they were born healthy and apparently breathing fine as it showed dad holding both babies in arms by mom’s head as she was sewn up.
but 35 weeks!!! broke my heart. they missed out on a lot of “in womb” growth!
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Awesome blog entry Sheridan! I have some things to add and some responses to others who have left comments:
1. Mine was simply a failed induction. Looking back and knowing now what I didn’t know then, I am horrified that they even TRIED. But L&D was empty (rare for such a huge hospital) and I suspect they just wanted to keep staff. I now know that it was doomed to fail from the start.
2. “Failure to wait”… very common in the hospital. Just two nights ago we had a doc who was very anxious to get home to her kids because her sitter had to leave. I’m not kidding. She didn’t want to leave her husband home with the kids alone. So she did a section on a mom for THAT REASON ALONE. Of course she told the mom that it was failure to progress. And indeed, she’d been at it all day… but still, it was not a reason to cut her open. She was anxious about the time and treated it like an emergency, failing to even wait for an assistant to get there first! It was atrocious!
3. To Alison above (Abby’s mom)… I’m curious… were you allowed to labor in several different positions? I often find (I work in a hospital birth center), that the moms with acynclitic babies have often had epidurals and have been forced to labor in bed the entire time. I’d be interested to hear whether or not you were able to be up and moving and still had an acync baby. I’m sorry that that happened to you!
4. More on acynclicity (is that a word?)… I think sometimes that once a baby gets TOO acynclitic, there is no other choice but to section. We had one the other night with horrific caput and moulding… she had been “sucked” into the birth canal sideways so far that there was no other choice and then breaking the seal of the “suction” in there was hard. I think the trick is to labor in many positions to begin with to avoid acynclicity in the first place. Of course that isn’t going to help all babies… but I think it would work on the vast majority.
5. To Mommy Michael above… that is truly horrific. OBs and many moms have NO CLUE just how risky it is to have 35-week infants. They look and act normal, but they are not. THey are premature and that comes with a whole host of risk factors including but limited to: hypoglycemia, feeding issues, jaundice, sepsis, temperature instability, increased risk of SIDS, and many other things. OBs are NOT telling moms about these risks when they induce moms early. They simply say, “They’re old enough and they’ll be fine.” Well, most of them time they are, but many times they are NOT. It’s awful. I ALWAYS talk to laboring mom of early babies BEFORE their babies are born to warn them about these risks.
Too many c-sections!!!!!!! They ARE risky!
Great post — I frequently get irritated by the term “emergency C-sections” being used to describe any C-section that was unplanned at the beginning of labor. The term “emergency” conjures up images of code blue, stat, racing down the hall, general anesthesia with big vertical incision, rather than the somewhat leisurely (by comparison) “emergency” C-section done an hour or so after the decision of “failure to progress.”
I agree that there are too many moms that are probably classifing their c-sections as “emergencies”. Many of my mom friends classify theirs as emergencies but I think a lot of theirs fall into “Urgent due to interventions”. Mine was categorized on my records as FTP (Failure to Progress (or Failure toWait)). I think it was a combination and due to interventions, induction and “Reluctant Mother Choice / Nothing Else Seems to be Working”. But really rather then Reluctant Mother Choice I would have labeled it as coersion and presented as the only option and my inablility at the time to continue to question my OB after I was rebuffed as well as not being informed enough.
I’m back with one more comment. I wanted to address the whole “failure to….” classification. Here’s one that will make your head spin…
In our local hospital, they are no longer allowed to use the term “failure” with regard to labor! My theory is that it makes the docs look bad… like they failed. And in truth, it’s typically true. “Their” induction failed. “Their” interventions failed. But they don’t want to be seen that way. So instead of saying that, we are required to say things like “arrest of labor” or “arrest of descent”. That way it makes the mother’s body look responsible and not the docs or their interventions.
OOOOH I am so linking to this later!
I personally get all horrified and say how sorry I am when a mom says she had an emergency cesarean. How scary that must have been, not being able to greet your baby, your family so concerned.
Met ONE who truely had an emergent c/s.
ONE.
The rest probably chalk me up as a raving lunatic.
whatever… to ME it isn’t emergent unless you are put under and wake up groggy hours later. DO NOT mess with the true horror/sorrow and fear of an emergency cesarean. An emergency is just that. Not a ‘well, you know the baby didn’t do so well after the pitocin/water breaking/epidural etc…. that is the emergency due to interventions.
bravo!
What about “maternal choice due to previous bad vaginal birth experience?” That’s what my upcoming c/s will be. I had a terrible labor (36 hours) with a failed epidural and unsupportive care providers. I know there’s post-op pain involved in a c/s, but compared to what I went through before, I’d still rather have a controlled c/s with a caring provider of my choice. I suppose it could fall under purely “elective due to fear of pain,” but frankly, I find that a little insulting. I’m not “too posh to push,” after all. I’m taking control of my own birth, and choosing an alternative to the misery I experienced last time. It may not be what everyone in my place would do, but it’s the only way I think I could truly “enjoy birth.”
I would love to see “Cesarean Recommended- Patient Refused.” If a successful vaginal delivery ensues, the recommending doc/CNM should feel embarrassed about his/her poor judgment in trying to get a patient to agree to unnecessary surgery.
We’ll never get a truly transparent picture of the c-section mess. It would be interesting to study how sections are perceived and reported by multiple parties. Interview doctor and mother, compare to birth certificate data, hospital discharge paperwork and how the surgery is billed for insurance purposes.
Thought of another study… taking your Care Provider Pressured category and getting a ballpark on how many of those suspected fetal macrosomia surgeries actually resulted in a macrosomic baby.
You should forward your post to Carol Sakala.
I was very empowered at one of my prenatal visits to the birth center: I met a woman who had pushed for THIRTEEN HOURS. Thirteen hours! Pushing! I was amazed! I had never heard of such a thing! But she was so grateful that she has been able to do it – and that the midwives at the birth center had allowed her to do it. There had been no fetal distress, just a long period of hard work, and SHE DID IT. I wish every pregnant woman could hear that story; maybe they’d be brave enough to stand up to FTP or “arrest of descent.”
I am so sorry you had such a negative birth experience. I believe strongly that we need to respect mother’s choices and SUPPORT them. I don’t judge moms for choosing an elective cesarean. I just want them to do the research and then make the best choice for them. It sounds like you have done that.
I have a whole series of posts on moms who choose cesareans http://enjoybirth.wordpress.com/2008/02/14/why-is-she-choosing-a-cesarean/ and how to support them. Because sometimes as childbirth lovers we get a little overzealous at sharing our joy of birth.
I put the elective due to fear of pain as an example. It could just as well read elective due to previous birth experience. Thanks for your input!
Mine would only be classified as coerced.
He was asynclitic and I was aware of that. I was forced to accept an epidural, and she undermined me by asking the anesthesiologist (out of my room) to provide a bolus quantity. This both paralyzed me from chest down and arrested my labor. Then, I was told she could try forceps – “but, he’d probably have brain damage… or, you can sign for the c-section”.
She lost her medical license for abusing patients less than a year later.
How many physicians get away with treating women like this? Lots… you’d be surprised.
In my records, the c-section was coded as “CPD” meaning his head was too big for my pelvis. He was nine pounds.
My last vbac (at home) was a posterior baby that weighed 10 pounds and 12 ounces.
I think there was probably room for a nine pounder, don’t you?
You have at least one blind spot. Not all emergencies are after the start of labor. Call it pre-eclampsia, toxemia, PIH, HELLP — sometimes it is so severe that attempting labor is not an option.
In my mind that would fall into unplanned emergency or unplanned urgent. It wasn’t planned, but it IS urgent or an emergency.
I agree, wayyy to many women use the term ’emergency section”. It drives me nuts. I had an “emergency section”… but for the delivery I still had my street clothes on, my husband was still en’route to the hospital, and I didn’t even sign any admitance or consent forms until I was in recovery and my baby was being worked on in the NICU…
The ambulance took me to the hospital, and I went from the stretcher straight to the operating table…
Coming from somebody who did have an emergency cesarean, hearing some women classify their non-emergency cesareans as emergencies does irritate me a bit sometimes.
Seriously…so you weren’t progressing and that is an emergency?
Nope…Class I HELLP with a visible liver outline through my skin and the baby starting to decel is an emergency.
Decision to incision was about 10 minutes. I was put under and lost a LOT of blood. Like 5-6 units.
Lori and others… I suspect that some women are calling their sections emergencies because that’s what they’ve been told. I work in a hospital and I have witnessed it first hand. It gets late, a doc wants to go home and doesn’t want to hang around the unit any longer. So she goes in and tells the mother that the baby is in distress and they have to get the baby out NOW. Then they run around and yell at the staff and ACT like it’s an emergency and so the mother really buys into that mentality. You see, it’s a lot easier for a mom to swallow that she needs surgery if everyone around her is acting like it. It makes the doc look like the hero for “saving” the baby. And it doesn’t give the mother any time to question the decision. All she hears is, “My baby is in trouble!” What mom, upon receiving that message, would think any differently. Aside from being a nurse and seeing this all the time, I also experienced it firsthand as a mom. For YEARS, I was duped into believing that my doc had heroically saved my baby. One day I learned and woke up and realized that yes, they did save him… but only after completely putting him in harm’s way first.
Disclaimer… lest anyone think I am labeling all docs, I am certainly not. Of course there are occasions that are *true* obstetric emergencies. And not all docs act like the one I described above. But unfortunately, it goes on a LOT more than I think the general public would like to believe.
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I almost had the emergency due to intervention in your example, but then the cord went back in (I know that never happens, but it happened to me!) and I delivered vaginally about 5 hours later. On the next baby I had an unplanned C-section, but I don’t know if it was due to natural causes or intervention. She was head-down when I was induced and before my water was broken. Two hours later she was presenting a foot and one hour after that she was delivered foot-first by c-section, after several tries to get the head out first. I didn’t ever feel her flip, but I got my epidural shortly after my water broke so I might not have felt it or it might have happened when my water broke as I tend to have a lot of fluid and she could have flipped in the gush. So I really don’t know. And it doesn’t matter to me. I would have preferred a vaginal birth (and I REALLY would have preferred the recovery after a VB), but I don’t think it was a mistake or a failure or anything else negative. Babies come into the world in all different ways and so far I have been blessed that all my different ways have resulted in a healthy baby.
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