After L&D tour I'm concerned about high C-Section %(FTM)

LeeLee86 · January 2014

At my tour the guide told me that the hospitals rate for C-sections is high and our whole area DC/NOVA is very high. I really want to avoid a CS if I can safely. (As a fitness professional I see how hard recovery is) I'm planning on a epi but have a "we'll see how it goes" attitude about most of labor and I also have a high tolerance for pain. She told me that laboring at home as much as I can is the best way to avoid a CS. I don't really understand that. Does anyone have experience with trying to labor mostly at home? Or with this type of advice? The guide was a nurse and a babycare instructor. Thank you ladies!!!! Xoxo

spacepotatoes · January 2014

I'm a FTM as well. The "labour at home" recommendation is pretty common and it's actually on my hospital birth centre's website as well. I think the idea is that by staying at home as long as possible, you don't run the risk of being admitted earlier than truly necessary and then having a doctor think you're progressing too slowly. From what I've read, it seems like more interventions get tossed out in that situation.

christieep · January 2014

I agree with trying to labor at home as long as possible. My doc had me go in when my contractions were still 6-8 minutes apart, wanted to discharge me once I got there and I ended up with pitocin which I think made things more painful. I didn't end up with a c-section, but I think things could have gone differently had I stayed home longer. Ask your doc when they want you to go to the hospital.

kat8805 · January 2014

Also, in what instances were those CS emergency, RCS, ECS, etc. If you are on the same page as your Dr, have expressed your concerns and felt you can trust them to meet your expectations of care and respect your wishes, I think you have no reason to worry. Every birth experience is different, not everyone has complications, not matter the method. And same for difficulties. We had an ECS in MD, sorry to skew the statistics :P

ETA even though we did and ECS, it was scheduled for our edd and DD1 had other ideas. I labored at home until my water broke because after the bitchy attitude I got from one of the other Drs in the practice, I wasn't going anywhere until I knew they would take me seriously.

chknma · January 2014

I never hear that about he DCMV having a high rate. Maybe heck the local board for some feedback?

I was induced with our first due, so I don't have first hand experience yet (not c/s). The things I think (aside from medical reasons) that can contribute to c/s are your delivering provider's practice attitude, l&d nursing support, (a great nurse can be such an awesome resource), how you prep for labor(classes, etc) and advocating for yourself. I would talk with your provider about your concerns. Also review things with your labor partner so they can support you with your wishes.

The challenge in going to the hospital too soon and getting an epi early can be slowing the natural birthing process and then needing additional meds to progress.

Maybe look into a doula for support if that's an option for your financial situation?

ShannonSky · January 2014

If going out to Leesburg is an option for you, I highly rec

ShannonSky · January 2014

Recommend the Loudoun Community Midwives if your priority is no Csection/natural birth.

IBackBevo · January 2014

I really wish I had been more aware of this issue with DS. I think you are VERY smart to educate yourself on this issue. I still may have ended up with a c-section (hard to say) regardless, but the fact that I learned later that my hospital has a 50% c/s rate does not calm my doubts any. I think laboring at home helps. I also think getting a doula is a very good idea. I really wish I had done that last time. When you are dealing with a stressful situation and in particular when your wishes are adverse to what a doctor or nurse is saying, you need someone there to advocate for you. I thought DH would do this for me. He didn't. And I was in no shape mentally or physically to fight the good fight. I also think a doula can be a good source of medical knowledge because I have found a lot of time doctors and nurses will use scare tactics on you. This happened to me more than once. I had one OB even try to delivery me 6 weeks early due to pre-e and I balked at the idea. I was lucky in the senses that the particular OB was willing to listen to me and allow a second opinion (an MFM) and the second opinion agreed with me. However, some doctors view you disagreeing with them as some sort of insult and it makes everything really hard when you get adversarial (sp?) with a doctor...had this happen and ended in a c/s. Also, you don't always have to time to research what a doctor or nurse is recommending to know if it is being recommended truly for your best interest or more for convenience. I think the doula can help when you have to make split second decisions.

I also think your OB plays into it a lot, BUT (and this is a big but) you also have to remember you may get a different on-call doctor who might have different ideas and it also depends on your L&D nurse because they are usually reporting to the doctor and their attitude can certainly sway things. Even if your doctor says they will be there for your labor, there are too many other circumstances that can come into play because they may have an emergency or be on vacation, etc.

I was ultimately told I had to have a c/s because LO was having heart rate decels. I was also high risk. Yet, I have heard of numerous other women who were much higher risk and had decels and a c/s was never even mentioned...especially when, like what I was experiencing, the heart rate came back up when they changed my position..which just indicated it was a positional problem. Because it was labor day and I got some on-call doctor who wasn't even a member of my practice much less my regular OB and I had a nurse who clearly didn't want to mess with me and was very "pro c-section" (told me that a c/s was better anyway because she had tearing down there and a c-section was better than that - which is complete bullshit - you can't compare one to the other when you haven't experience both and those I know who have generally say a tear is easier to heal from than major abdominal surgery), I think they just basically made the easy call and I was too scared and naive to know better. I think a doula and a hospital staff that wasn't trained to call c/s at the slightest hint of trouble might have made all the difference in the world.

Sorry this went on so long. I got carried away.

spinsoffresonance · January 2014

I wouldn't worry too much about the csection rate on its own. It depends on a lot of things. first, how high is high? Is that the rate for all births or first time births only (all births would be higher than FTM since RCS are more common than VBAC)? Is your hospital a small community hospital or a major medical center with high risk cases being referred there from the entire state? More high risk patients equals more csections. For comparison my hospital is a major center that caters to high risk patients throughout New England. The c-section rate for FTM is 26%, high but not crazy. I would start being concerned if you're at a community hospital with FTM csection rates above 35%

deanna1313 · January 2014

This is very interesting to me. I need to sign up for our classes(becoming last minute) and I was wondering if I will find out anything about my hospitals c-section rate at these classes. I don't know where else to find it. They don't say anything about it on their website.
I also read something about laboring at home and I wasn't sure about what they meant. Thanks for clarifying. I'm ten minutes from my hospital so it doesn't make me worry to much to wait it out a bit.

boymum2014 · January 2014

Hospitals are a business at the end of the day they want you in & out as quickly as poss so if you are progressing slowly,it's usually not good enough for them & they will give you pitocin,which in effect can often lead to wanting an epi as contractions become much stronger.Epidurals can slow things up even more hence the increased risk for them going the c sec route. Watch a documentary called business of being born if you can-it really puts things in perspective

LeeLee86 · January 2014

It is a community hospital at 41%. That data is from a 20210 study, I can't find one earlier. I do think that is pretty high. Both hospitals my OB delivers at are about the same, one is larger). I really like my OB and my practice has a midwife as well who I see every other visit. My sister (who's a nurse and had 4 kids) will hopefully be my advocate if she can get here. Any advice for laboring at home as long as possible? Thank you! https://www.cesareanrates.com/storage/state_pdfs/Virginia_Cesarean_Rates_Report.pdf

LeeLee86 · January 2014

@kitchencolors your experience sound like what I am going for. Thought water breaking was the star of labor though? Ugh so much to learn!! I think my DH wants the epi more than me lol he's encouraging it bc he hates to see me in pain. I went through some crazy sciatic pain a couple weeks ago (body went into shock + throwing up etc) and I think it freaked him out. We are also about 5 minutes away from the hospital. It really helps to hear these stories/ advice, thx!

MrsT2008 · January 2014

Being in a large metro area like DC, I'm not surprised the rates are high. I wouldn't base any decisions based on the number alone until you know the details behind it. Educate yourself on how you want things to go, talk to your OB, etc.

kat8805 · January 2014

MrsT2008 said:
Being in a large metro area like DC, I'm not surprised the rates are high. I wouldn't base any decisions based on the number alone until you know the details behind it. Educate yourself on how you want things to go, talk to your OB, etc.

On this note, also consider the demographics of birth in the area. Maybe such a high CS rate can be related to more home/birth center births that don't need to involve those particular hospitals.

On the home laboring, we were also 5 minutes from the hospital. I woke up in labor, and knew I was in labor because I had not had a single contraction the entire pregnancy. I had regular, consistent, and very slowly escalating contracts from 7 am until midnight, when my water broke. They didn't really "get down to business" until after my water broke, we went to the hospital, I was admitted, and in a bed in L&D. But every woman's labor is different. If I was anything like my mother, I probably would have delivered DD1 quicker by pushing than it took to get me to the OR for my CS.

EmilyGolden1 · January 2014

There is definitely a difference between a C-Section and an Emergency C-Section. 41% would freak me out too. I am in Chicago and the rates are quite high and I am traveling to a neighboring suburb to a midwife practice with a a 12% c-section rate. Laboring at home (from what I have read and heard) helps you to relax in your own surroundings and potentially progress a bit faster. When you go the hospital, the clock starts and they want you in and out- (not all, but many and likely this is your hospital)

If you stay at your hospital...I suggest you go in pushing.

glowworm0166 · January 2014

I was in early labor from 4am - 6pm (steady contractions every 10 min until from 4am - 7am and then on and off until 6pm). At 6pm I started more serious contractions and labored at home until midnight. My husband went to sleep at 9pm (bum) and I was too uncomfortable to sleep so I took a long bath and then hung out (mostly on the bump actually) until midnight. At midnight my contractions went from every 7 min to every 3 min and were getting rather painful. My hospital was an hour away so I sarted freaking out so we left for the hospital. I didn't have DS until 9:30 the next morning so I could have stayed home longer but didn't want to chance it being a first time mom with contractions so close and being so far from the hospital. I delivered without an epidural and for me personally the only benefit to being at home was that I could be in the bathtub (they do not allow women to labor in the tub at my hospital). Otherwise I couldn't have cared less where I was. That said my hospital was VERY hands off so I didn't have to deal with any pressure about interventions even though my labor was long. I agree with pp that had someone been pressuring me I don't think I would have had the energy or concentration to fight my case because I was using all my energy on labor and DH certainly would not have helped in that regard.

annabeanybee · January 2014

It sounds like a birthing class would probably help you out. I like the Bradley method, personally - the class is a bit pricey, but covers everything, including newborn care, and most Bradley people see birth as a normal part of life, not a medical occurrence. I found my doula through my class instructor, and she was WONDERFUL. DH was unsure about her at first, but now he says it's the best money he ever spent and recommends one to everyone (she will be attending this birth as well). If you can't afford a certified/licensed (not sure what they get) doula, you can always find one in training (ours was in training with DS - we paid half price, and she got experience hours toward her training).

Like PPs, I would recommend laboring at home as long as possible, especially since you're so close to the hospital. It's more comfortable for you anyway. Oh, and my water never really "broke" with DS - the bag did rupture at some point after I went into active labor, but he was stuck like a little cork in front of the fluid, so I just felt a tiny trickle. That's actually an awesome thing to have happen, cuz it gives you way more oomph for pushing, plus baby gets a little shower as it comes out.

MunchkinMoon · January 2014

@LeeLee86: what hospital? I'm at Georgetown and they've been very supportive in trying for me to leave the c/s as an absolute last resort!

gutsysneakers · January 2014

@LeeLee86 - also in the NOVA area so I'm curious as to what hospital? Was in one of the INOVA hospitals in Alexandria/Fairfax/Arlington?

LeeLee86 · January 2014

@glowoworm0166 I100% agree that the bathtub is my reason for staying home. Weird as it sounds thats the only place I really feel relaxed. They do not allow that at all at my hospital. As a dancer I also feel better if I can move around, using different positions and they also do not allow any of that with a epi.

@annabeanybee we are doing a class but it's an all day "express" class and it's not until April 6 bc our schedules are so crazy ;( I will look into our doula options though thank you!

@MunchkinMoon and @Jcrewgirl85 it is an INOVA hospital which I've had really good experiences with (in surgery and ER) but they are very strict on procedure with L&D so I think it will be up to me to advocate for what I want.

thx

sthomas1222 · January 2014

WORRY. Seriously, worry about a high c/s rate. It shouldn't matter what patient population they see. I was at the largest hospital in our area that takes on extremely high risk cases. Their c/s rate is 18% and VBAC success rate is 90%. High risk =/= c/s.

Laboring at home is a great idea. Active labor is now classified as 6cm, not 4cm. I called our hospital when I was 36w and having 15 minute apart contractions for 6 hours. They told me to call back when they were 4 minutes apart lasting a minute for an hour (4-1-1) as the 15 minutes apart could last days. They stopped around 3am and I went 2 more weeks before I was induced for high BP.

Also, an "emergency" c/s is any c/s that isn't scheduled. To me personally, it's an emergency c/s when they aren't asking my permission, they're wheeling me down the hall and telling me what they're going to do. If the doctor is calmly sitting on the edge of your bed discussing things with you take the time to go over BRAIN:

B - Benefits

R - Risks

A - Alternatives

I - Intuition

Nothing - What happens if we do Nothing?

A lot of times this will buy you other options or at least more time.

Happypost · January 2014

As a FTM I find this all very interesting. My birth classes start next Monday and I'm so set on having a natural birth.

gutsysneakers · January 2014

@LeeLee86 - you may want to check out Virginia Hospital Center in Arlington too - I've heard wonderful things about them from coworkers/friends who delivered there...not sure if your OB is affiliated with them though. Good luck!

Xath · January 2014

Jcrewgirl85 said:
@LeeLee86 - you may want to check out Virginia Hospital Center in Arlington too - I've heard wonderful things about them from coworkers/friends who delivered there...not sure if your OB is affiliated with them though. Good luck!

I delivered my first two at VHC and will be there for my 3rd as well. Nothing but positive things to say about the care we received.

There are a few reasons the NOVA hospitals have such high CS rates:

1) There are a high concentration of high risk (level 3B/C NICU) patients in the DC area. Children's, VHC, and Inova Fairfax are, and I think there are several others as well. Higher risk pregnancies have a higher likelihood of cesarean, and they tend to funnel to these hospitals.

2) There are a ton of options for natural birthing centers, midwives, and home births in this area. These births only go to the hospitals if problems develop.

3) There's also a higher preponderance of elective cesareans in high-education, high-pressure career fields (doctors, lawyers, politicians, etc), and DC has a very high concentration of these career fields. As a result there are also many practices in the area which cater to the "planned birth" crowd which contributes to the higher rate.

There are enough options around here that you should be able to find an OB/practice that will work to get you the birth experience you're looking for.

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