Quick, Quicker, Quickest Operative Starts to A C-Section

There are lots of terms for doing things, "quickly". Remember the "clean up your room, honey" when you were a kid, and our, "sure Mom, right away," response? Well, gynos have a whole different vocabulary, rhetoric, patois, argot, maybe some outright cant, when it comes to "right away". This problem of getting the start to a c-section Quick, Quicker and Quickest has been flummoxing gynos and their hospital administrators to no end. We have committee meetings that have been renaming these same terms for literally decades. And you think I jest. I do not.In fact who carries the watch, you got it, kind of like carrying that big stick. And for those hospitals that cannot get the quickest starts to their operative approaches to birth, the end result, women have not been given the chance to VBAC.

So clear this right up, what goes on here. We have an entire vocabulary of terms that apply to getting your c-section started when it's determined that it's the time to get the baby out surgically: Elective, Emergent, Urgent terms. And those performing the surgery must be either "available" and the "immediately available" and the "on-site" available, depending upon how quickly the surgery must start. We can go on and on with these terms, and what they mean. For women in labor, once we decide to do a C-section, why dawdle around, Quick is in order. In the Medical News and Perspectives section of the May 5th JAMA the recent NIH Consensus Panel findings regarding VBAC's were discussed and dissected.

When it comes to problematic situations, Quick is not good enough. And Quicker is necessary. Quicker when it comes to most Emergent C-sections is a "decision to incision" (in obstetrical terms from the doctor "calling" time to do the operation to actually starting the operation) time of 30 minutes. But research says you need to be the Quickest of all, 18 minutes to save a baby and mom in the case of a ruptured uterus in the case of VBAC attempts that need intervention. A feat that practically speaking requires a poised and ready team. The panel wanted to down-grade Quickest back to just Quicker, or perhaps even just Quick in the actual guidelines.

And then, what is the realistic outcome if the readiness of the hospital is not sufficient to handle the complications of the baby or the mom should that 1/5000 occurrence of a rupture at term? No legal protections to address the liability concerns of physicians or the hospitals who have to provide the care. So to quote JAMA, it's "problematic". And to quote the qynos, we can move very quickly.

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