WARNING...potentially graphic images of and about surgery.
ahhh, Friday afternoon. On fridays I am supposed to be in the ultrasound clinic, learning how to do level II ultrasounds. To be frankly honest I hate doing ultrasounds. I can do all the basics, tell you if you've got a boy or a girl. Approximate the baby's weight with a growth scan, and all that good stuff. What I hate about ultrasounds is all the little tiny detailed stuff. Looking at the small vessels in the heart, and trying to measure just exactly how big is that little fold of skin on the back of the neck. you see, that takes patience. which i do not have (although i am learning through adoption). I plan to never do high risk ultrasounds when i am out of residency. There are people trained specifically for that craziness. So often on fridays i play catch up on my leftover work from the week.... or blog. :)
after my last post about the frustration with the c/sections here, a couple of people brought up elective cesarean sections. Right now OB is pretty much my life. I do OB more than i do anything else. I'm at the hospital more than I am home. And in spite of that, i still love to talk about it. so hopefully i don't bore you guys. and if i do bore you, there are like a million awesome posts out in adoption blog world right now, so you can go check those out.
Remember, my point of view is a little different. I'm a resident, so i get paid exactly the same amount whether the baby comes out of the abdomen, or out the "regular" way (which from here on out will be referred to as the vajinga, hoo-ha, or cookie). Also, i am in the military. Which means there is a combination of more rules, and less rules, and none of the rules make any sense.
I get asked to perform an elective cesarean about once a month. mostly by girls about 19 or 20 years old. we call it the "too posh to push" mentality. Hey, if Britney spears can request a c/s, why can't everyone? Sometimes i get asked to do it because the patient is scared. I had 1 lady who had reportedly never been "intimate". no, it wasn't the immaculate conception. she was single, and underwent artificial insemination. Which is great. I'm happy that she is going to be a mom. But she also wanted a c/s. This was a mature, adult, educated woman. She was terrified of pushing a child out. I can actually kind of understand her mentality, but when you think that the alternative is having your abodmen cut open, your muscles divided, your uterus then cut open, the alternative doesn't sound too fun either.
how natural is this??
anyway, i go back and forth on this whole issue. Which brings up the point, to what level do we allow an adult to make their own decision about their medical care. You are allowed to choose vaccinations vs. no vaccinations. You can choose circumcision vs. no circumcision. You can sign up to have implants put in your breasts, or fat sucked out of your butt. In fact, you don't get thrown in jail for drinking vodka, or injecting heroine while you're pregnant. So why not allow a women to choose if her baby comes out of her abdomen or her hoo-ha.
I am a big fan of autonomy, but i don't know where to draw the line. I'm still internally debating this whole issue. So if you have comments, i'd love to hear them.
Lately i guess i think that if someone requests a c/s, and gets very thorough counseling about all the complications...serious ones to include a hysterectomy or colostomy if there is bowel injury, and not so serious ones to include wound breakdown.
If after all the counseling and questions and answers the patient STILL wants a c/s, i guess i'm pretty much cool with that decision.
And to dispel a couple of common rumors about vajinga deliveries
-the act of BEING pregnant contributes more to pelvic relaxation and urinary incontinence, not necessarily the act of delivery
-little tiny 110 pound women CAN successfully deliver 8 and 9 pound babies. I've seen it. so "it's not gonna fit" is not an indication for a c/s. the only way to know if it will come out is to try.
and i guess that's basically all for now.
In an upcoming post, if you're not too tired of cookie talk, Cosmetic Gynecology. And yes, that is an actual specialty, in fact i am going to a conference of Cosmetic gynecologists in none other than Las Vegas in December.
still no travel dates, but I'm suprisingly still pretty relaxed about it. I am still hoping for september, so maybe starting next week i will have some freak out sessions.
11 comments:
Emilie-
I love your post. I really am neutral about whether you should be able to choose c/s or not. I had my son by c/s (not planned) and I had no complications. I was up and about the next day.
I hope you hear a travel date soon!
I too loved your post. I have no bio cildren, just step and adopted. No infertility, I just don't have a bio clock I guess...just a mama one. At any rate, your post made me really think on many different levels.
LOVE your post! I had both and that was because they lost the pulse of my son during labor (apgar scores of 0-1-2). The c-section saved his life, but I went on to have the next one by the other way.
I pray you get your travel all soon!!!
YAY!! Thanks for posting from a very educated perspective! I, too, struggle with patient autonomy when it potentially conflicts with the patient's best interest.
I watch the specials and read the articles on body dysmorphic disorder and can't figure out if I think it's ethical or not for surgeons to agree to cut limbs off because their patients have a mental condition that makes them feel like they were meant to be an amputee. But at least the surgery cures the mental disorder in this case.
But as far as elective c/s goes, I think it is unethical for OB's to agree to perform them with no indication other than "too posh to push" syndrome. I AM all for patient autonomy, but I DO think, at some point, OB's have to say "I didn't spend 4 years of medical school and 4 years of training to agree to perform procedures without indication that could do the patient harm." That said, I do support cosmetic plastic surgery, and one could argue that it's the same thing. Is having a big nose REALLY an indication for surgery? An interesting debate.
For some reason though, c/s is just more black and white for me. I think it's because as doctors, we are enabling it to become c/s to become the trendy, preferred alternative to something very natural and usually safe - childbirth. I agree with you; babies are not supposed to come out of holes in bellies. That's why women are born with holes in their vajingas! HAHAHA, I love your lingo!
Whoa...after seeing the pics I am ever so glad mine came out the traditional tunnel! I went no epidural for the second (not by choice) and wish I had for the first. Fear is an amazing thing, it works your mind in funny ways. Kind of like a 5 year old getting a shot....the agony leading up to it far outweighs the actual poke.
Yummy photos! (just kidding,obviously) You brought up an interesting point about autonomy. Obviously I'm a big fan of patients having agency and choice when it comes to medical care, but I guess my thought process has been more of the "you can't make me do that!" rather than the "you have to let me do this!" So I really don't know what I think about whether or not womem should be allowed to choose c-sections when they aren't medically indicated. From my own personal experience with a c-section (emergency situation where the ob was attempting a version and my daughter's heart rate plummeted to almost non-existent) I just don't understand why someone would ever choose to have one if it isn't needed. I don't know if my recovery was worse than normal due to all the intense pushing on my abdomen/uterus just prior to slicing me open, but it was horrible. I think what they really need to stress to women considering elective c-section is that they will live in fear of needing to go to the bathroom for at least a week. They will also be afraid to: laugh, sneeze, cough, hiccup, sit, stand, walk, breathe and eat (because then you'd have to go to the bathroom). Maybe that would convince them otherwise.
Ewwwwwwwww. I don't know why anyone would want to be cut open if they didn't have to, but that's just me I guess.
You're tagged, BTW :)
I am all about informed consent and patient autonomy. But the thing with OB is, there are two patients--and an elective c-section with no medical indication is NOT in the best interest of the baby, or the mother according to the newest study that came out yesterday that more women are dying in childbirth as the ridiculous c-section rate in this country rises. (And all of the the other evidence out there) Also, I think if someone chooses a c-section for no medical reason, they should have to pay out of pocket for the difference in cost. Society should not be liable, when there are children without insurance out there, to pay for such absurdity.
And again, as I commented in an earlier post, I completely agree with E. Having done it both ways, the c-section recovery was absolute agony.
OH, and cosmetic gynocology--interesting topic! I thought it was ridiculous until I actually saw what some women were living with and it can actually be a quality of life issue. Looking forward to your post!
I've never had a bio baby, but I have had abdominal surgeries (ruptured appendix requiring two surgeries, one of which was fairly invasive) and I cannot imagine actually WANTING someone to go in and slice open my belly again. On top of that, I can't imagine taking care of a newborn baby while dealing with post-surgery issues. No thanks.
great subject! My first bio child was 22 hrs of labor, he was large and sunny side up which they didn't know till my 4th trip to hospital, 3 1/2 hrs of PUSHING, to then have a c-section! I was NOT going throught THAT with my second and she was also big so I scheduled a c-section. Also my first had some maconium (sorry can't spell it) after all of that so I did not want to risk it again. c-sections are NOT easy to recuperate from though!
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