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”.