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40-year-old mom with diabetes, pre-eclampsia shocked that doctors advised a C-section

January 10, 2015

Just because I had a zillion complications and my baby was born practically dead:

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I had been at the hospital for two days in induced labor, unable to get out of bed or eat, tethered to a labor-inducing oxytocin drip. The doctors started to talk about stalled labor, a stuck baby, and going to the operating room. I. But I was also concerned that the medical technology my doctors and I were relying on to keep me and my baby safe might lead to interventions that weren’t necessary.

***

Admittedly, I was a more complicated case than the average. I became pregnant with my first child at the age of 40, an “elderly” first-time mother in the jargon of obstetrics, and my pregnancy was complicated by gestational diabetes. Dietary changes and exercise prescribed for me weren’t enough to keep my glucose levels optimal for my baby, so in my first trimester I started taking insulin and went to see a maternal-fetal-medicine obstetrical practice, which specialized in high-risk pregnancies. I was impressed with these specialists’ thoughtful rather than reflexive use of technology and their willingness to admit uncertainty.

***

Research has shown that, compared with having a doctor listen to fetal heart tones with a fetascope or a hand-held ultrasound device, electronic monitoring decreased the rate of seizures in babies but did not change infant mortality or cerebral palsy rates. It also has been found to increase the rates of Caesarean deliveries.

***

The intrauterine pressure catheter revealed that, although I had been receiving oxytocin for almost 24 hours, my dose had been adequate only for the last two hours. I needed more time. However, other physicians present — none of whom had actually evaluated me — said I should have a Caesarean delivery as soon as possible.

Fortunately for me, the hospital was very busy that night with other urgent deliveries. My husband, my sister and I were left alone until 6 in the morning, when the chief resident returned and said, “It’s now or never!” It had been 21 hours since the amniotic sac was broken.

***

My son came out blue and not breathing. I listened for crying but didn’t hear any. I barely heard the doctors say it was a boy. Meanwhile, as the NICU unit was summoned to attend to my son, I began to hemorrhage from the prolonged exposure to oxytocin. My physicians seemed so unprepared for the delivery. Perhaps they really had already earmarked me for a C-section, and the delivery room simply wasn’t ready for a vaginal birth.

After we were both stabilized, they handed the baby to my husband; I was too exhausted to safely hold him.

There are circumstances where surgical births are necessary to protect babies, mothers or both. There is, however, broad agreement that the current U.S. rate of about 32 percent is too high — the World Health Organization sets 10-15 percent as the goal worldwide — and not warranted by concerns for fetal or maternal health.

***

I knew that the reasons I was being given to proceed with a Caesarean delivery were subjective. I had friends with the right medical expertise to call on, and even then, I barely escaped a Caesarean I didn’t need. In the end, my son is healthy, I’m fine and we had the vaginal delivery that epidemiological data suggests was safest for both of us.

Shorter version:

A woman whose pregnancy is already at high risk because she’s 40 years old–and she’s also on insulin for diabetes and exhibiting symptoms of pre-eclampsia, oh, and she’s also has been in labor for 24 hours–delivers a son who’s one step away from death when he finally emerges,

And she’s complaining that the doctors wanted her to have a C-section–but the World Health Organization says that’s a no-no because we in surgery-happy America want to prevent women from experiencing the joy of natural childbirth like in the Third World.

One of the interesting things about this story is that there isn’t even any evidence that any doctor tried to pressure her into anything–although the bedside manner of some of them left something to be desired.

But it’s great to feel like a victim.

h/t: Dr. Amy Tuteur (I confess to stealing her art, too)

Posted by Charlotte Allen

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