A Dr. speaks: Spotlight on c-sections here in Massachusetts

1 November 2011 at 2:19 pm Leave a comment

This article came out in The Boston Globe Magazine just this week. Written by an OB, it’s a pretty amazing story of the Massachusetts c-section rate. Because the Globe online is now subscription-only, you might or might not be able to follow this link (or try to find the article yourself via another search; if so, it’s “The C-Section Boom,” by Adam Wolfberg). Still, I’ll leave you with these few paragraphs from near the end of the article.

[M]y patient’s cervix finally became fully dilated. With the next contraction, she pulled her legs back and pushed as hard as she could. But now the baby’s heart rate, which had concerned us throughout the labor, dipped again with each push. Research suggests that even the most worrisome heart rate pattern rarely predicts injury. Still, I had to make a decision.

In my gut, I believed that my patient’s baby would make it safely to delivery. But I couldn’t predict how long it would take: an hour, two? Forceps or a vacuum wasn’t an option – the baby’s head was still too high up within the pelvis. I’ll admit that it crossed my mind that when my shift ended in two hours, my colleague would be annoyed to take over responsibility for a patient pushing that long and with a less-than-perfect heart rate pattern.

I sat down in a chair beside my patient’s bed. “I’m not worried about your baby right this minute,” I told her. “However, you have a lot of pushing yet to do, and I’m concerned that your baby will not tolerate it. My recommendation is that we do a caesarean now. I think it’s the safest thing.”

Under bright lights, 20 minutes later, we delivered a little girl, who emerged screaming and pink. My patient and her husband were delighted and thanked me for guiding them to a safe delivery. I didn’t spend time second-guessing my decision: Everyone was healthy; the new family was content.

I sure hope there’s a healthy amount of irony around these words. The bold–emphasis added–above is mine, of course.

–Christina

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