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Once a Cesarean—ALWAYS a Cesarean

1970’sThought process…….“Once a Cesarean—ALWAYS a Cesarean”

This was the adage I was taught in nursing school and on my first days in the Labor and Delivery Suite.  Any pregnant mother with a history of having had a Cesarean, who showed up at our door with any signs of labor was quickly prepped for surgery. No question about it. She was not allowed to labor. It was the “rule”.  Prematurity was not as much of a concern or worried about as much as the possible and most likely complication of ruptured uterus!

Caesarean Sections (Cesarean or C/S) in the mid 1970’s were nearly all performed under General Anesthesia in my little neck of the woods. There were very few done with spinal anesthesia until the late 70’s into the 80’s. Epidurals used for C/S came even later. The mothers’s were given a pre-op med and were often dozing before anesthesia. The cold pale green tiled main O.R. was the birthing place for these moms, not that many may have remembered much.

Emergency C/S were done for things like prolapsed cord, placenta previa or audible drop in the FHT (via Fetoscope) especially if we saw meconium. Then some were done for things like malpresentation (like a shoulder), transverse lie or really prolonged pushing (2nd stage) -CPD- (cephalo-pelvic-disproportion). This was sometimes diagnosed by x-ray flat plate of the abdomen or pelvimetry. A lot of the OB’s did Leopold’s first but didn’t make a decision to C/S based on that.

We did NOT automatically do a C/S for Breech presentation or face presentation. I remember being taught how to be a good assistant in a breech delivery. Some of our doctors were quite skilled at delivering breech’s. Years later, when the rare imminent delivery arrives at our door in breech position… The OB calls for the OLD Fashioned L&D nurse! Guess that’s me! Most new OB’s are never taught this important skill.

Those moms scheduled for Repeat C/S were admitted the afternoon before surgery. The admission process included lab work, a full shave of the abdomen from breasts to mid thigh. That area was then washed with a Betadine or Phisohex scrub. They were allowed lunch but sometimes had a clear liquid dinner ordered. The SSE was given day of admission and some doctors also ordered a Fleets enema in the am pre-op. Most were given a sleeping pill the night before surgery because it was felt that they would recover better if well rested prior to surgery.

The mother was taken up to the OR on a stretcher. Our OB L&D staff was not allowed past the OR’s double glass doors. We were all taught strict sterile technique and required to utilize that for every delivery in the Delivery Room…even though we know the vagina is not sterile! We had to be practicing a lot of the same approaches in our area with shoe covers, hats, masks and sterile technique with regards to supplies etc.. We still were not allowed in the room. The OR Circulating nurse was designated to take care of the baby. The baby was brought down from the OR on the elevator, barely covered, in the Kreiselman. There was no paperwork except a footprint ID sheet and very little if any report. We were told the time of birth and Apgar score. That’s about it. Sometimes we were told: ”this one took a little work to get going.” We didn’t take vital signs of babies or do much paperwork. They were mostly just considered “healthy”, not really a patient. Some of the older nurses had an attitude of they make it or they don’t. I’ll have more on that particular aspect of care in future stories.

Mom was recovered in the main Recovery Room. She returned to us hours later, groggy, but reacted or awake. She still had not seen her baby and may not until the next designated “feeding time”. What surprises me when I think back to this….. is that no one complained. This was just accepted practice.

I looked at some of our old logs to see if I could come up with an approximate C/S rate. During the mid 70’s, over a few 6 month period groups, I calculated our C/S rate to be fairly consistent at approx 16 to 17%. Interestingly, during the same periods…the rate of “general” anesthesia and low outlet forceps for a vaginal delivery was nearly double that at 30 to 35%! Amazing and sad how many women slept through the delivery of their babies.

Another interesting tidbit of the culture of this generation…..the older nurses would record the name of a mother in the delivery log as “Mrs. Deborah Jones” or “Mrs. Norma Jean Baker”.  Some of the younger ones, myself included, just used first and last name. The mother deserved her own identity. I wonder if log entry’s from the 50’s or 60’s would be logged as “Mrs. Tom Jones” or “Mrs. Richard Baker”.

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8 Comments Post a comment
  1. Again, I find your posts fascinating.

    When did Klaus and Kennell’s theory on bonding time get implemented? Did it catch on in the late 70’s? Early 80’s? It just rocks my world that babies laid alone in the nursery being fed bottles while mom recovered and slept.

    So the knock ’em out, drag ’em out vaginal births (complete with generous episiotomy, no doubt) were in the 30-35% range? How many women requested this? Was this operative vag delivery at maternal request or doctor behest? Was it seen as humane?

    Or was it just the way things were done?

    The older wave of birth activists did so much for women. The default comment in every internet thread on birth is “Well, 100 years ago, birth was perilous and barbaric.” Sounds like 30 years ago, birth was perilous and barbaric! Advocating for more humane birth practices has provided a sort of check and balances service for the obstetric industry, hasn’t it?

    April 15, 2009
  2. Birth_Lactation #

    Thanks Jill… The emphasis on Bonding (influenced by K&K) happened right around 1980 although there were many wishing for extended time with their newborns before that…it just wasn’t approved because remember..the nurses “owned” the babies. Aghast! I worked at 3 different hospitals between 1978 and 1981 PA and FL and each had a little different transitions to a more natural approach despite the increase in EFM through out labor.
    As far as the operative forceps delivery of the mid 70’s, I can only remember what I actually witnessed as to why… and that was mostly by uneducated maternal request which was quickly honored. There were NO consents for this type of procedure. And yes, the episiotomy’s were generous… too bad for you if you had a short perineum because then you got a generous mediolateral epis.. I remember being in the DR for extended repairs. No father in site, Baby in the Kreiselman, mom asleep, anesthesia and OB docs shooting the breeze. Sad but true.

    April 15, 2009
  3. I just found your blog. I wanted to let you know I love reading!

    April 16, 2009
  4. I just wrote a paper for my English class on “Vaginal Birth After Cesareans: The Benefits Outweigh the Risks.” I will be posting it on my blog later on, (after it’s graded) if you’re interested.

    I learned a lot while writing that paper, especially regarding how low the chances of rupture really are when you have a low-transverse incision. I hadn’t know a lot of this, and considering I am going to be attempting a VBAC anytime in the next month (I’m due May 10th) it really opened my eyes to my options, and what the real statistics are!

    April 21, 2009
    • Birth_Lactation #

      Thank you for reading and for your comment Samanthavv, I hope you have a beautiful birth however you decide to proceed. I am glad you are doing your research and making true informed decisions! I’ll check you blog out. Thanks!

      April 22, 2009
  5. nursingbirth #

    I love reading your stories!! As a relatively new nurse (I have been a nurse for 3 years) it reminds me of how far we have come, and yet, it is also frustrating of how far we have left to go as a society!! I look forward to more posts on the reflections of your past 35 years as an OB nurse and I wish I worked with someone like you!! You are truly a great resource!! IAlso, it is so sad that vaginal breech deliveries are a lost art. I truly feel like our society has LOST something! (P.S. “OLD nurse” hahaha! Hey, at least they didnt call you late for dinner right?! Haha!)

    ~Melissa
    http://www.nursingbirth.com

    April 23, 2009
  6. I love reading these stories. Thank you. I’ve only cracked the surface on your posts because I keep running out of time to read all the blogs I’ve recently discovered, so I’m still trying to figure out – how did an L&D nurse, who saw all of this go on, turn out to be the advocate that you are? How did you not just become institutionalized like the rest of them?

    I honestly have seen so few L&D nurses who know a single thing about normal birth. They have all been drinking the kool-aid. So why are you different? (if your whole story is somewhere, just link me to that and I’ll be happy to read it.)

    May 1, 2009
    • Birth_Lactation #

      Thanks for the great comment and kind observations about me.. Maybe I’ll write my whole story for a post. LOL I think I always have been alittle “ahead of my time” in my little corner of the world….. I was always researching things, being involved and it has always been very important to me to provide the most currently recommended care. I always have been and always hope to continue to be an optimist with a very positive open-minded attitude. My glass is half full and I always have a “maybe”… I attribute these traits to my parents..esp my mother. I entered this profession at the beginning of many changes in maternity services so I embraced this revolution as a young “student” of my career. I feel I have that advantage over some who may have already become stagnant.. Let me tell you…that stagnant attitude is so very contagious and difficult to overcome. I face it every day. So I’m here to tell the stories. I do have some fabulous nurses that I work with and would entrust my own children to their care. There are more of us out there… Thank you

      May 2, 2009

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