Ethics of Pushing for C-Sections?

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Hey Everyone,

I wasn't sure under which forum to post this, so I went with the safest bet under "General Nursing." I have to write a nursing school admissions essay and write about a current ethical or moral healthcare issue and how it may change or affect nurses. The essay is to be 400-600 words, which isn't all that many words truthfully.

I have had a difficult time narrowing down a topic, as there are so many ethical healthcare issues, but I want to write about something that truly interests me. I'm really interested in women's health and I thought about doing something with abortion, but that seems too controversial. I looked into birthing issues and was doing some reading on home births vs. hospital births where I found an interesting article on the increasing number of c-sections in our country. Some are claiming that the numbers are tied to doctors and hospitals pushing for these procedures as they are better for profits. I know I just grossly generalized the issue there, but that was the simplest way I could put it.

I guess my question is, do you think this is a valid ethical concern for nurses? Moreover, it seems like there isn't much nurses can really do about it, correct? I read in one article that nurses have been written up when complaining to administrators that doctors have been rushing the patient. Ugh, I feel overwhelmed because these are such big issues and there is so much to write about. . . . Any thoughts?

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Specializes in Nurse Leader specializing in Labor & Delivery.

IMO as someone who works in obstetrics, if doctors are pushing for C/S, it's not because of profits, it's because of fear of litigation.

I had a WONDERFUL experience recently in which I was taking care of a laboring pt whose fetal heart tracing was pretty crappy all night. I wasn't comfortable continuing to labor her, and I was pushing the doctors for a C/S (I'm a homebirthing midwifery student, so if *I* was pushing for a C/S, it had to be pretty bad). However, the doctors were able to look at the overall picture, saw that the baby was not acidotic, and were okay with continuing with cautious watchfulness. The woman did end up having a lady partsl birth and the baby was perfectly healthy.

So no, I don't agree that most doctors are pushing for C/S, and I certainly don't believe it's due to increasing profits.

IMO, the reason why there are more C/S are 1) increased fear of litigation, 2) increased rates of elective induction, and 3) increased rates of epidural use.

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While it is great that this doctor wasn't pushing for a C-section, anecdotal evidence in just one instance doesn't mean that many doctors are not pushing for C-sections, whether the reason is profits, fear of litigation, or something else entirely. I think it's a good ethical topic in healthcare, even if nurses can't directly do anything about it, and I think it would make for a good and interesting essay.

IMO as someone who works in obstetrics, if doctors are pushing for C/S, it's not because of profits, it's because of fear of litigation.

I had a WONDERFUL experience recently in which I was taking care of a laboring pt whose fetal heart tracing was pretty crappy all night. I wasn't comfortable continuing to labor her, and I was pushing the doctors for a C/S (I'm a homebirthing midwifery student, so if *I* was pushing for a C/S, it had to be pretty bad). However, the doctors were able to look at the overall picture, saw that the baby was not acidotic, and were okay with continuing with cautious watchfulness. The woman did end up having a lady partsl birth and the baby was perfectly healthy.

So no, I don't agree that most doctors are pushing for C/S, and I certainly don't believe it's due to increasing profits.

IMO, the reason why there are more C/S are 1) increased fear of litigation, 2) increased rates of elective induction, and 3) increased rates of epidural use.

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400-600 words? That's so short! I'd narrow your topic even further. How about pushing for sections in VBACs? There is a lot of information out there, but it's still a fairly narrow topic.

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Specializes in Nurse Leader specializing in Labor & Delivery.
400-600 words? That's so short! I'd narrow your topic even further. How about pushing for sections in VBACs? There is a lot of information out there, but it's still a fairly narrow topic.

I didn't even see that! I agree, the topic is too broad for such a small essay.

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Specializes in Community, OB, Nursery.

Moved to OB/Gyn nursing forum

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Thanks for all of the replies so far. I know, it's basically a short essay on a really broad topic, especially considering some of the "ethical or moral" issues in health care that first come to mind (my mind, at least), are euthanasia and abortion - two HUGE topics. Moreover, in addition to addressing the issue, one has to address how it will affect the role of nurses!

But please, keep your thoughts coming! :) As someone with no experience in this field, just a strong interest, I like hearing what others have to say. Thanks!

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400-600 words? That's so short! I'd narrow your topic even further. How about pushing for sections in VBACs? There is a lot of information out there, but it's still a fairly narrow topic.

This is a great idea! Looking into it now!

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Specializes in ICU, Home Health, Camp, Travel, L&D.

Look at ACNM's position statement on VBAC vs. ACOG's position statement. That alone would give you a good jumping off spot.

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Interesting essay topic! Definitely cite/compare position statements, as suggested above. The CDC might have some stats that you can use regarding the change in C/S rates. I like the idea of focusing on VBACs, too. I just finished reading a couple books that you might find interesting: "Pushed: The Painful Truth About Childbirth and Modern Maternity Care" by Jennifer Block and "Birth: The Surprising History of How We Are Born" by Tina Cassidy. Obviously they may be too long to finish before your paper is due, but if you are interested in this topic I'd check them out. Disclaimer: prepare to be totally ****** off, if natural childbirth (or at least the option of natural childbirth) is something you are passionate about. Also, you can watch Ricki Lake's documentary "The Business of Being Born" on YouTube. It's not that long. We watched it in clinical for OB.

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Specializes in pediatrics.

Another issue in the obstetric area is Baby Doe Legislation. You'd probably get some big points for this one, as no one really knows much about this. .laws were passed back in early-mid 1980s that babies could not be denied medical care based on disability or potential for disability despite the wishes of the parents, unless treating would be futile. What this caused was extremely aggressive neonatal care being forced on smaller and sicker newborns. Many of these 1 pound infants survive with serious life-long disabilities. In this health care climate, this is a HUGE ethical issue, as the law says that these babies must be saved, but then the enormous costs for their care throughout their lives is not there. If interested, I can cite some resources for you. Will keep the list short though since your "wordage" is limited.

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Another issue in the obstetric area is Baby Doe Legislation. You'd probably get some big points for this one, as no one really knows much about this. .laws were passed back in early-mid 1980s that babies could not be denied medical care based on disability or potential for disability despite the wishes of the parents, unless treating would be futile. What this caused was extremely aggressive neonatal care being forced on smaller and sicker newborns. Many of these 1 pound infants survive with serious life-long disabilities. In this health care climate, this is a HUGE ethical issue, as the law says that these babies must be saved, but then the enormous costs for their care throughout their lives is not there. If interested, I can cite some resources for you. Will keep the list short though since your "wordage" is limited.

Thanks, this is quite interesting, too. Please do send info along, if even just for my own reading (though this may be easier to condense into a short essay, so I may use it, too).

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