Saturday, September 26, 2009

Preventing c-sections

Earlier in comments, someone criticized a labor with interventions. First off, I agree on trying to minimize the medicalization of pregnancy and labor. Mother nature is smarter than me and my pediatric colleagues. I try not to do elective inductions and my patients are told this AT THE FIRST APPOINTMENT. Labor works better if it comes on spontaneously. Plus the risk is lower that the baby will need my colleagues in peds.

Now, there are indications for inductions. And I have no hesitation to do them if I feel the benefits of delivery are more than the benefits of continuing the pregnancy.

I've looked at this month's stats thus far. Note that I do not do VBACs due to medmal insurance coverage. Rural areas have a more difficult time with the "suggestions" for dealing with one in labor, so I can't comply with the requirements the insurance company has. So anyone with a previous c/s gets an elective repeat c/section sometime in their 39th week. I don't want to add to risk, I work hard to prevent the c/s in the first place. I offer versions for those with breech/transverse fetuses.

For women with a planned vaginal delivery, 1 section out of 23...a 95% rate of delivering vaginally. My overall vag delivery rate (including those with planned c/sections for repeat, previa, malposition) is 81% (22/27). Most people were spontanteous labor. Several were inductions at 42 weeks, one induction for GDM, one induction for fetal anomaly with me wanting her to deliver during the week when peds would be available, two inductions for IUGR (the one failed delivery).

I have been trained to do c/sections...and they can be life-saving. But a large part of my time on L&D is being an overpriced cheerleader: "You can do this! Push! I can see head!" My value is knowing when to intervene and when to hold back. It's an art...one where I'll always be learning. Should I have called the section sooner? Did I call the section too soon? Should I have tried an operative vaginal delivery first (I admit, I do do nice vacuums)? Why do I have a bad feeling in my gut...there's nothing objectively wrong.

I readily admit, most of the time I'm kinda superfluous to the process of delivery. But those times when I'm not...that's when I earn my gray hair.

5 comments:

Grumpy, M.D. said...

You are a good doc.

Don't let the hecklers get to you. They aren't at the bedside.

Mr. Condescending said...

I laughed at the cheerleader part :)

dh418 said...

A c-section saved me and my daughter when I had severed pre-eclampsia. I know they can and do save lives.

If I was having a baby and in your area, your c-section rates would make me want you as my doctor.

Dragonfly said...

A crash c-section and an anaesthetist with antiarrhythmic drugs saved my life and my mothers life way back when (I was in NICU as well but not for long and nothing too invasive). She did go on to have a very natural VBAC 4 years later with my sister. Then a gynae saved my mothers life 5.5 years ago again, so much love to you guys.

MNgal said...

We did a c-section earlier this year because nobody (and I mean
NOBODY) could find this woman's cervix. It was a very weird situation to say the least.