Pinky has a great post up about women who can’t push adequately because of their epidural who then ask for cesareans. (And, may I add, they may have an unrealistic idea of what the normal pushing a.k.a. 2nd stage of labor should take, which is, on average, 48 minutes or so for a first time mom. Up to 2 hours is definitely normal and safe if the fetus does not appear to be in distress. If they’re asking for cesareans after 30 minutes, there is a misconception there that needs to be corrected.)
Here is my reply-turned post:
I do not believe in the patient-as-customer paradigm in which a patient can request a non medically justified intervention, like a cesarean section in a slow but within-normal-range 2nd stage (or as an elective section without labor, for that matter.)
I am going to try to refuse to attend these kinds of deliveries when I get to make the calls. I have a feeling as a student on rotations and as an intern I will probably have to participate in many procedures like unwarranted inductions with poor Bishop’s scores and good biophysicals.
But, when I call the shots, I will tell the patient the pros and cons of all of their options. I will make it clear from early on in their pregnancy that I do not choose to perform cesarean sections (or any other medical interventions, for that matter) that do not have good evidence of improved health outcomes.