Tough decision - Elective C or not ?

"Paul W" wrote in message
...

I would note, however, that when I started this post (which was
shortly after our last visit to the hospital), I was'nt even aware
that the option of no C, no intervention was even viable.

The docs words ere something like - Its a large baby so we won't let
u go over term. No mention of doing nothing...

I love it when the doctors say things like this. Yes, there may well be
very good reasons why your wife shouldn't go too far overdue, or
shouldn't have a vaginal delivery - and I'd say check them out so you
both have fully informed consent. But I always laugh when I hear "We
won't let you go over term". What is the doctor going to do? Come round
to your house and drag you in to hospital?

If your wife and you do your research and feel you would rather go into
labour normally and then have a section; or do the research and opt for
induction; or do the research and go straight to theatre, the important
thing is to do the research /yourselves/ - don't let the doctor bully
you (they may think they're gods, but your wife should know you from
experience that they aren't!). Goodluck with your decision, whatever you
decide.

In article ,
"Paul W" wrote:

"Vicki S" wrote in message
...
"Circe" wrote:
I wouldn't normally recommend an elective c-section, but I'm a realist:
you're on the road to one anyway, so why not cut out the middle man?

I agree with Circe. You really sound like you've made up your mind
already and like nothing you read that disagrees with your preference
makes any impact. Happy c-section, and I hope you don't want a lot of
children.

Vicki,

Hmm. Pretty pointless post really.

May I suggest if u don't like my views or my attitude or whatever you ignore
this thread rather than post this sort of rubbish.

Paul, you are not the only person reading this thread.

--
-- Vicki
Married DH May 21, 1995
Ima shel DS, born 11/16/99; and DD, born 5/19/02.
"Stay-at-home" Ima since October 2002.
An ounce of mother is worth a pound of clergy. -Spanish proverb
I may not currently be pregnant, but I look pregnant, does that count?

"Paul W" wrote in message
...
I'm a little insulted that you seem to have brushed my opinions off in
this
way.

Well, I'm a bit insulted that you've brushed off the many well-reasoned and
well-researched opinions of those of us who have suggested that you have
other options, so I guess we're even, eh?

As I said in another post,. if I was'nt interested to learn I would'nt
have started this post, would I ?

Well, it's hard to say. Nearly *everyone* posting to this thread has
repeatedly told you both that ultrasound estimates of fetal weight are
unreliable and that intervention of any sort is not required or even
desirable in the event of a large baby. Some of us have even backed this up
with research evidence.

Did you even bother to read Henci Goer's article on fetal macrosomia and
induction, to which I provided a link for you? That one document provides
dozens of references to studies which show that babies assumed to be big
often turn out to be quite average and that when intervention is taken
because the baby is assumed to be big, the outcomes are poorer than when the
baby really *is* big but no one expects it to be and nature is allowed to
take its course.

However, your last paragraph seems to have hit it on the head...

I would note, however, that when I started this post (which was shortly
after our last visit to the hospital), I was'nt even aware that the option
of no C, no intervention was even viable.

The docs words ere something like - Its a large baby so we won't let u go
over term. No mention of doing nothing...

And that's why many of us have been pointing you to the research on this
subject. Your doctor is NOT practicing evidence-based medicine--he (she?) is
practicing convention-based medicine.

*Conventionally*, the obstetrical approach to potential fetal macrosomia is
to intervene, typically by inducing labor prior to the due date. This
practice developed because doctors *assumed* that large babies were a
problem and that inducing labor before the baby got *really* big would be
better, leading to fewer c-sections, shoulder dystocias, and other
complications. The problem is that when you look at actual outcomes, you
discover that inducing due to suspected fetal macrosomia *doesn't* do any of
the things doctors thought it would. It doesn't decrease c-sections, it
increases them. It doesn't decrease shoulder dystocias (though I don't
believe it increases them, either). It doesn't, in fact, appear to decrease
complications or improve outcomes in any way.

Now, all of this might reasonably cause you to wonder why doctors continue
to recommend induction for suspected fetal macrosomia. And the simple answer
is that this is what they've LEARNED they're supposed to do. It's what
EVERYONE does. It's become standard of care, even though the evidence
doesn't support it, and that means they're afraid that if you experience a
problem because the baby IS big and they didn't do the STANDARD thing,
they'll be in trouble. The irony is that people rarely sue or raise
malpractice concerns when a doctor DOES something, even if that something
was actually ill-advised and brought on iatrogenic complications. People
tend to assume that things would have been WORSE had the doctor NOT
intervened and are, ironically, GRATEFUL to have been subjected to the
interventions that led to a C-section and a baby in respiratory distress in
the NICU because they assume the outcome would have been less favorable had
the doctor done nothing.
--
Be well, Barbara
(Julian [6], Aurora [4], and Vernon's [18mo] mom)

This week's special at the English Language Butcher Shop:
"She rose her eyebrows at Toby" -- from "O' Artful Death", by Sarah Stewart
Taylor

Daddy: You're up with the chickens this morning.
Aurora: No, I'm up with my dolls!

All opinions expressed in this post are well-reasoned and insightful.
Needless to say, they are not those of my Internet Service Provider, its
other subscribers or lackeys. Anyone who says otherwise is itchin' for a
fight. -- with apologies to Michael Feldman

Paul W wrote:

I would note, however, that when I started this post (which was
shortly after our last visit to the hospital), I was'nt even aware
that the option of no C, no intervention was even viable.

The docs words ere something like - Its a large baby so we won't let
u go over term. No mention of doing nothing...

Have you thought of getting a second opinion? When my OB and I disagreed on
an induction date I asked for a second opinion. The second high risk doc,
my OB, and myself were all in the room together discussing the issue. After
that consult we all were able to agree on a course of action. I felt much
better and I think my primary doc felt like she was off the hook if the sky
fell in since there was a second opinion.

It seems the doctor has scared the dickens out of your wife and that is to
bad :-( She should be making this decision by knowing the facts and
following her heart, not out of fear.

Are you familiar with a doula? If your wife decides to try for a vaginal
delivery I would really recommend a doula or midwife. She is going to need
a lot of support. Not because the labor will be hard or because the baby is
big, but because she is going to be scared and the seeds of doudt have been
firmly planted at this point.

--
Nikki
Mama to Hunter (4) and Luke (2)

"Paul W" wrote in message
...
"Taniwha grrrl" wrote in message
...
Circe wrote:

BTW. My wifes a registered nurse (and a theatre recovery
nurse at
that!) so knows a bit about things.

She knows what recovery from surgery is like; what she
doesn't
realize, I suspect, is how much *harder* recovery from
surgery
generally is than recovery from a normal vaginal birth.

Not to mention taking care of a newborn baby while
recovering from surgery, I don't think she'll have
experience in that. You can't pick up your baby to comfort
him when he cries, you can't put him to the breast, you
can't even pull the bassinette close by to gaze at him
without using that buzzer to get the staff to come in and do
it for you. Your totally dependant on other people to help
you care for *your* baby in those first day's after surgery,
it can be very depressing. It was torture to me, as I'm very
independent, to have to ask someone to pass me my baby when
she cried so I could put her to the breast.


Yep. Agreed. This is something, obviously, neither us have any experience
in...

But many of us have. Some of us have had this experience repeatedly.

When my 4th baby was born vaginally after 2 cesareans (1 singleton, 1 set of
twins), I kept asking the nurses if I could do things. Like have the baby in
the bed with me at night, and pick her up by myself, and have her in the
room when nobody was there with me. The answer was always "Yes, of course"
as if I was asking silly questions. But I wasn't. I was going by my previous
experiences, when I was *not* allowed to have the babies in bed with me, or
pick them up by myself (ha, I could hardly walk), or have the baby in the
room with me when I was alone. I wasn't out of pain with my first cesarean
for something like 6 weeks - I mean, I was still taking pain medications. I
was still taking them 2 weeks after the second cesarean...and having to take
care of my firstborn also. And I was lucky - I didn't get an infection in my
incision either time. Many women are not so fortunate.

I haven't seen an answer yet in this thread to a couple of questions:

1. What is it about a "large baby" that frightens you and your wife so
badly? If you can express your fears, perhaps they can be addressed with
further cites from peer-reviewed medical journals.

2. On what do you base your aversion to the use of venteuse or forceps? I
will assume that it is not because of pain for the woman, since you say your
wife intends to have an epidural (and I can tell you that if the epidural
works, pain is not an issue with the venteuse).

3. Do you consider the risks (immediate and long-term) from surgery to be
preferable for mother and/or child than the risks from venteuse or forceps?
If so, why? (Yes, I do know that venteuse and forceps can cause birth
injuries.)

3. What coping methods for labor have you researched and practiced using in
the event that an epidural doesn't work, doesn't work completely, or cannot
be administered for some reason? (They don't always work. I have even met
one woman whose cesarean was performed with an epidural that failed, and
this is not as rare as you may think.)

I agree with your assessment that birth is an "inexact science". Actually,
no, I don't agree. It isn't a science. It's a natural function of the female
body. Like other natural functions, it may sometimes need help, but that
doesn't make it less *natural*. I'm concerned when people approach it as a
science, because often when nature doesn't fit into science's "box", science
*makes* it fit. And since I've been there twice, and didn't like the
experience either time, I hope others may avoid going through what I went
through.

--angela

Nikki wrote:

Paul W wrote:

I would note, however, that when I started this post (which was
shortly after our last visit to the hospital), I was'nt even aware
that the option of no C, no intervention was even viable.

The docs words ere something like - Its a large baby so we won't let
u go over term. No mention of doing nothing...

Have you thought of getting a second opinion? When my OB and I disagreed on
an induction date I asked for a second opinion. The second high risk doc,
my OB, and myself were all in the room together discussing the issue. After
that consult we all were able to agree on a course of action. I felt much
better and I think my primary doc felt like she was off the hook if the sky
fell in since there was a second opinion.

Good idea Nikki. We did this, when we had our big baby scare. It bought
us an extra weekend to think about it. Turns out I went into labor that
weekend before getting the second opinion.

It seems the doctor has scared the dickens out of your wife and that is to
bad :-( She should be making this decision by knowing the facts and
following her heart, not out of fear.

Yup. Same thing my doctor did to me....

Are you familiar with a doula? If your wife decides to try for a vaginal
delivery I would really recommend a doula or midwife. She is going to need
a lot of support. Not because the labor will be hard or because the baby is
big, but because she is going to be scared and the seeds of doudt have been
firmly planted at this point.

I so wish I had done this. If I had a doula, or midwife, I may have been
more likely to stick out my labor longer, and may have gotten some
constructive ideas on how to get baby to descend. As it went, we opted
for the c-section after 12 hours of labor, with no progress. It turned out
OK, but my big regret is not giving a vaginal birth more of a chance, and
not having a more supportive environment for that. I do not regret going
into labor at all, it was good for me and good for baby. I am very glad
I declined the elective c-section (without trial of labor) in favor of a second
opinion.

Mary

"Ericka Kammerer" wrote in message
...
Kereru wrote:


Mind if I ask why you say that? I ask because I am having a large baby
(looking to be 10-11lb by 40 weeks) and the midwife isn't keen to let me
go
too far past term so induction may come into the picture.


Be really cautious here--as so many have posted, estimates
can be really off, there is no good evidence that induction or
elective c-section for suspected large baby improves outcomes,
and larger babies are not necessarily more difficult to birth.

It's probably a pretty good estimate. My first was 10lb 8oz and consistently
measured smaller than this on by both fundal height scan and just the sheer
size of me!The hospital OB agrees with you on the last bit. Induction is
unlikely unless he's looking really really huge and not before term and
c-section without a trial of labor isn't an option they (or I) will
consider.




So do you mean that induction is worse then c-section in general or do
you
just mean that in the case of this woman who's scared of a vaginal
birth?


I interpreted her to mean that if you don't want a vaginal
birth anyway, an induction is a waste of time and energy for all
involved ;-) Also, since induction (particularly if done in a
less favorable situation) can increase the odds of a more painful
labor and instrumental or surgical delivery, it's not necessarily
a nice option for someone already afraid of vaginal birth.

That's what I thought she meant but I wasn't sure




I REALLY want another vaginal birth, I'm pretty much terrified of having
surgery.


If you really want it and plan for it and have a good team
to support it, odds are you *will* have another vaginal birth,
even with a large baby. Also, all inductions are not created
equal. If somehow you find yourself in a situation where an
induction really is the best thing, you may be able to get by
with a much more gentle approach than cervical ripening followed
by loads of pitocin.

My midwife thinks that as my second baby a bit of cervical ripening at term
should do the trick. I've also had some accupuncture. I hope I don't get to
induction but thankfully my midwife and the Dr she is consulting with both
want to avoid intervention as much as possible.

Thanks for your input

Judy


Best wishes,
Ericka

Judy ) wrote:

So do you mean that induction is worse then c-section in general or do you
just mean that in the case of this woman who's scared of a vaginal birth?

I REALLY want another vaginal birth, I'm pretty much terrified of having
surgery.

In your case, induction is a much better bet than it is for a primipara since
you *have* had one baby vaginally already. I still wouldn't be at all inclined
to do it unnecessarily, but I would expect it to be *on average* easier both
physically and psychologically than for a first-timer.

--Helen

Paul W wrote:


You seem to come up with some great stuff. If you don't mind me asking - are
you a healthcare professional ?


Thanks for saying so ;-) I'm not really a healthcare
professional, though I have done health care research in the
past. Most of my information I get from Medline, which anyone
can search (and occasionally I stop by the library to check
the full text of the study if I can't get it online). There
are also some books that I find very handy and believe to be
very well researched, like Henci Goer's book and Enkins et al.'s
_Guide to Effective Care in Pregnancy and Childbirth_. I
do have a background in research, which makes interpreting
the results a bit easier.

Best wishes,
Ericka

On Tue, 30 Sep 2003 14:46:25 +0000 (UTC), "Paul W"
wrote:

Then why are you asking for opinions and arguing? If she wants a
c-section, let her have one. You said that she is a nurse. She is
medically with it enough to figure out the risks etc.

Just let it go...

And is there any harm in finding out as much as you can before the final
decision needs to be made?

But you are not that keen to find out that much information. You are
just arguing your side. We have given you tons of good information
about why the whole idea of induction and/or c-section for a
*suspected* large baby is a bad, bad, bad idea, and you are still
arguing your side.


--
Daye
Momma to Jayan
"Boy" EDD 11 Jan 2004
See Jayan: http://jayan.topcities.com/