I have opened the "new post" page half a dozen times, meaning to start something (anything!), but I keep getting distracted and forget what I was thinking about or where I was going with it. Nothing seems to stick... I know I have stories to tell, opinions to elaborate upon, but when I actually sit down to write, my mind goes blank. It's like Blockbuster Syndrome: a well-documented (by me, at least) disorder in which one wants to rent a movie, one has a mental list of several films one would like to see, and then when one enters the video store, it's "Movie? I wanted a... what? Video? What's that? Um..." Very, very frustrating.
(If I were clever, I would now present some interesting obstetrical analogy here. Rest assured, I have nothing.)
So. It's Cesarean Awareness Month once again! Yes... let's go with that.
I kicked off CAM with an elective primary section. Well, not me, personally, of course. My patient, a 24-year-old primigravida, delivered her son by cesarean on Friday... for absolutely no reason at all. There were no indications-- nothing in her history to necessitate major abdominal surgery. The OB's dictation states "The patient, over the course of this pregnancy, has requested a cesarean." There is no indication that he counseled her about her apparent fear of labor and delivery, or tried to dissuade her in any way from taking what is unquestionably a more dangerous route for herself and her child. He finishes, rather weakly, "She does show some signs of CPD."
Um... CPD? Really? Really?? Forgive me; I know "CPD" is a convenient label, the diagnosis of choice for physicians wanting to justify their surgical terminations of their patients' pregnancies. But shouldn't one give a baby a chance to negotiate the pelvis before pronouncing it "disproportionate"? How, exactly, does one diagnose "cephalopelvic disproportion" without allowing the passenger to give it a go, so to speak?
This gargantuan baby, by the by-- so monstrous as to be unable to fit through his mother's pelvis, according to the OB-- weighed in at a whopping 7 lbs, 11 oz. And the mother came from recovery complaining of intractable pain-- pain that took several doses of morphine to manage,leaving mom too groggy to breastfeed initially-- so baby is now on formula. Chalk up one more success for the American way of birth.
Here's another one: a 17-year-old sectioned on Friday-- a few hours after my patient-- is walking the halls. When asked, "Why did you have your cesarean?" she replied, "Because I was 38 weeks and my baby wasn't in the birth canal."
/jawdrop/
Honestly, what is wrong with these obstetricians? Why is that acceptable-- to cut open a teenager and give her such a ridiculous reason for it? In reality, this girl was a failed induction: after 12 hours of pitocin (cranked up to the max, no doubt), she did not dilate past 3 cm. Why? Because she wasn't ready to go into labor. Her baby was not ready to be born!
Does she know that? Of course not. She trusts her doctor. He said so; it must be true. I happen to know-- because a friend of mine was at the nurses' station and heard the conversation-- that the three cesareans that were performed back-to-back-to-back last Friday (that's not including the scheduled elective primary I alluded to above) were done for no more pressing reason that the respective OBs (including the 17-year-old's doctor) wanted to be done with their patients. In the words of my friend, another obstetric nurse, "They didn't want to mess with them all weekend."
That's right. Three babies were surgically removed from their mothers because three OBs didn't want their weekend plans interfered with. Tell me, please, whatever happened to "First, do no harm"???
The mom who elected her cesarean is hurting. She asked me earlier, with tears in her eyes, "How long is it going to hurt like this?" I could only tell her that I didn't know, it varied from woman to woman, but that it would get better... slowly but surely. And in my heart-- I shouldn't admit this, but I'm human-- I couldn't feel totally sorry for her... because she chose this, you see. She elected it.
Cesareans suck. Recovery hurts, even without the added challenges of caring for a newborn. Didn't she think to ask? Did she think that by circumventing labor, she would avoid pain? Why didn't her doctor tell her what she was in for?
Judging by the patients recovering from cesareans today on this floor, doctors play all their cards close to the vest. They don't see fit to share much information with anyone. Can I blame a primip for fearing labor-- something she's probably seen only in idiotic Hollywood depictions-- when it's the OB, the so-called expert in birth, who perpetuated the fear and granted her wish for an unnecessarean?
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