c-sections

[obgrl]

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Hi all -
I like a lot of things about ob, but recently saw a couple of c-sections that are making me think twice. I loved surgery and so went in there expecting to like c-sxns too. But it was so much more bloody and so much just plain pulling with hands instead of using instruments, not to mention the speed at which they go, that it seemed quite barbaric to me. Why I'm writing is b/c i've heard that many OB residents also felt this way wen they first saw the procedure. If some of you have felt this way, can youp lease tell me how that feeling changed for you? Was it when you actually took part? Also if those of you who didn't feel that way could write that would help too, as maybe I really shouldn't consider this field if i had that reaction... ??
thanks!

 

[Diane L. Evans]

[QUOTE=obgrl]Hi all -
I like a lot of things about ob, but recently saw a couple of c-sections that are making me think twice. I loved surgery and so went in there expecting to like c-sxns too. But it was so much more bloody and so much just plain pulling with hands instead of using instruments, not to mention the speed at which they go, that it seemed quite barbaric to me.

once you get to the uterus and incise it is actually safer to use your hands instead of instruments... Now using hands to deliver the baby is a must unless you use pipers in a breech. Also you question about the speed was it an emergent C-section? The goal is delivery of baby in one min. from skin incision. Also ACOG recommeds that decision to proceed to C-section after attempted vaginal birth has failed to delivery of infant should be 30 min., 15 min. if for distress-- so the scalpels could be flying because it was a distress situation. Think of this: getting the patient from an L&D room to prepped and on a surgery table takes about 5-7 min. Hooking up instruments and getting neonatal staff and anestesia ready 5 min. this leaves 3 min. for getting surgically dressed and getting the baby out...

As to all the blood, yes there is twice the blood volume in pregnancy. And hemorrage is a concern that's why they grab the uterus and massage it to control bleeding.

The surgery in itself is quite an art and one must be very knowlegable of anatomy avoiding ureters and major blood vessels like the uterine artery both of which I have known to be injured at once I thank god I was not in the OR at the time!!!!!

But please consider the entire aspect of the career before making a decision based on a single operation.... Feel free to write me with more questions


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Diane

Also controlled crash sections must be an aspect of OB training. One needs to know how to perform the surgery at ligtening speed in case there is a real need i.e terminal bradycardia or occult cord prolapse.