OBs doing unnecessary C-Sections and inductions

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I have read a lot of nurses talking about how obstetricians will perform unnecessary C-sections or will induce while there isn't a medical need. I find this very unethical and I am looking to write a paper about this in my healthcare ethics class. I hope to bring this issue up and make others aware of it so that hopefully someday in the near future this can be taken care of. What I was wondering is, do any of you know where I can find an actual article that is written about this? I have to have an article to go along with my paper. Any links would be great thank you! Also any thoughts oer comments on this subject are very welcome.

this sounds along the same lines as the documentary by ricki lake, "the business of being born" or something like that.

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sahm02, you are absolutely right. Every day I hear women talking about how they wish their doctor would "hurry up and take this baby!". They act like having a baby 6 weeks early is no big deal.

I wish people would see how big a deal it is! My twins were born 8 weeks early and luckily only had to be in the hospital for 3 weeks. They (also luckily) have no longer term effects, as yet. They will be 2 in less than a month and the biggest problem was that my son had reflux.

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Specializes in L&D,Wound Care, SNC.

Thankfully, this does not really occur where I work. I think part of the reason is that it's a military hospital. Our docs and CNMs will not even consider an elective induction until the woman is 39w0d with good dates (i.e. 1st tri u/s for dating).

Where I worked perviously....now that is a different story. Many IOLs for TOBP at less than 39 weeks, admitting women in latent labor with orders to start pit if no cervical change in 2 hrs, AROMing at 37 weeks (no medical indication). Elective primary c/s under general anesthesia b/c the patient was terrified of needles. The anesthesiologist had fit about that one, but did it anyway. I could go on and on. This was my first L&D job and I was so disheartened when I thought L&D was like this across the board. My current job is such a breath of fresh air!

I am leaving my job in a month and I am so sad. I told myself I would never work in an L&D unit like the first one again. I am going to be very picky when I start looking for my next job.

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Tumblin, A. 1993. The domino effect. International Journal of Childbirth Education 8 (3): 36.

This would support the idea that an elective induction could lead to other unnecessary procedures that could cause harm to the mother or fetus.

Technical Working Group, World Health Organization. 1997. Care in normal birth: A practical guide (summary). Birth 24 (2): 121-123.

They outline 14 common procedures that are often overused. You might find induction and cesarean there, but I'm not positive.

Elective cesareans:

Lowe, N. 2003. Amazed or appalled, apathy or action? Journal of Obstetric, Gynecologic and Neonatal Nursing 32 (3): 281-282.

Minkoff, H., and F. Chervenak. 2003. Elective Primary Cesarean Delivery. New England Journal of Medicine 348 (10): 946-950.

Ryding, E.L. 1993. Investigation of 33 women who demanded a cesarean section for personal reasons. Acta Obstetrica Et Gynecologica Scandinavica 72 (4): 280-285.

Starr, C. 2003. Elective cesarean section: A new dividing line for OBs. Contemporary OB/GYN Archive,June 2, 2003. http://obgyn.pdr.net.

Induction as a risk factor for cesarean:

Martin, J.A., B. E. Hamilton, S.J. Ventura, F. Menacker, and M.P. Park. 2002. Births: Final data for 2000. National Vital Statistics Reports 50(5): February 12, 2002. Hyattsville, MD: National Center for Health Statistics. Available at http://www.cdc.gov/nchs.

Maslow, A.S., and A.L. Sweeny. 2000. Elective induction of labor as a risk factor for cesarean delivery among low-risk women at term. Obstetrics and Gynecology 95(6): 917-922.

Seyb, S.T., R.J. Berka, M.S. Socol, and S.L. Dooley. 1999. Risk of cesarean delivery with elective induction of labor at term in nulliparous women. Obstetrics and Gynecology 94(4): 600-607.

Risks of cesareans:

Enkin, M., M.J.N.C. Keirse, J. Neilson, C. Crowther, L. Duley, E. Hodnett, and J. Hofmeyr. 2000. A guide to effective care in pregnancy and childbirth, 3rd ed. New York: Oxford University Press.

Cunningham, F.G., N.F. Gant, K.J. Leveno, L.C. Gilstrap, J.C. Hauth, and K.D. Wenstrom. 2001. Williams Obstetrics, 21st ed. New York: McGraw Hill.

Lowdermilk, D.L. 2000. Labor and birth at risk. In Maternity and Women's Health Care 7th ed. St. Louis: Mosby.

Wagner, M. 2000. Chossing a cesarean section. Lancet 356(9242): 1677-1680.

You could also go to the American College of Obstetrics and Gynecology's website (www.acog.org) and look for their recommendations concerning induction and cesareans. The World Health Organization has recommendations too. The United States Department of Health and Human Services puts out a Healthy People document every 10 years that lists the objectives regarding health for the following 10 years. The reduction of the cesarean rate has been on it since 1990, at least (that would be the Healthy People objectives for 2000). These recommendations by prominent health organizations supports the belief that elective cesareans are detrimental, otherwise there would be no need (other than financial) to reduce the rates.

This is all info I got from my childbirth educator materials. Good luck!

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Specializes in L& D / GI NURSE.

ok if i remember correctly cdc.gov has some info, on c sections rates. so would nih(national institute of health) march of dimes has info on gestational ages of infants and per state, oh and the big one medicaid and medicare services...and your local department of human services website in oklahoma ours is OKDHS.org im sure your state would be like this... CDC is very good for this one because on delivery of babies moms are asked questions for vital statistics the info goes to cdc and nih.. good luck... c/s rate when up to a high i remember 2 years ago 36% for the country at the time im 100% sure because of inductions... do me a favor and prove...

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
When I had my 4th baby I was offered a c-section for no reason at all. I had 3 previous natural delveries and was having no problems. I still dont understand why the Dr asked me if I wanted a c-section.

THAT is horrible!

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Tumblin, A. 1993. The domino effect. International Journal of Childbirth Education 8 (3): 36.

This would support the idea that an elective induction could lead to other unnecessary procedures that could cause harm to the mother or fetus.

Technical Working Group, World Health Organization. 1997. Care in normal birth: A practical guide (summary). Birth 24 (2): 121-123.

They outline 14 common procedures that are often overused. You might find induction and cesarean there, but I'm not positive.

Elective cesareans:

Lowe, N. 2003. Amazed or appalled, apathy or action? Journal of Obstetric, Gynecologic and Neonatal Nursing 32 (3): 281-282.

Minkoff, H., and F. Chervenak. 2003. Elective Primary Cesarean Delivery. New England Journal of Medicine 348 (10): 946-950.

Ryding, E.L. 1993. Investigation of 33 women who demanded a cesarean section for personal reasons. Acta Obstetrica Et Gynecologica Scandinavica 72 (4): 280-285.

Starr, C. 2003. Elective cesarean section: A new dividing line for OBs. Contemporary OB/GYN Archive,June 2, 2003. http://obgyn.pdr.net.

Induction as a risk factor for cesarean:

Martin, J.A., B. E. Hamilton, S.J. Ventura, F. Menacker, and M.P. Park. 2002. Births: Final data for 2000. National Vital Statistics Reports 50(5): February 12, 2002. Hyattsville, MD: National Center for Health Statistics. Available at http://www.cdc.gov/nchs.

Maslow, A.S., and A.L. Sweeny. 2000. Elective induction of labor as a risk factor for cesarean delivery among low-risk women at term. Obstetrics and Gynecology 95(6): 917-922.

Seyb, S.T., R.J. Berka, M.S. Socol, and S.L. Dooley. 1999. Risk of cesarean delivery with elective induction of labor at term in nulliparous women. Obstetrics and Gynecology 94(4): 600-607.

Risks of cesareans:

Enkin, M., M.J.N.C. Keirse, J. Neilson, C. Crowther, L. Duley, E. Hodnett, and J. Hofmeyr. 2000. A guide to effective care in pregnancy and childbirth, 3rd ed. New York: Oxford University Press.

Cunningham, F.G., N.F. Gant, K.J. Leveno, L.C. Gilstrap, J.C. Hauth, and K.D. Wenstrom. 2001. Williams Obstetrics, 21st ed. New York: McGraw Hill.

Lowdermilk, D.L. 2000. Labor and birth at risk. In Maternity and Women's Health Care 7th ed. St. Louis: Mosby.

Wagner, M. 2000. Chossing a cesarean section. Lancet 356(9242): 1677-1680.

You could also go to the American College of Obstetrics and Gynecology's website (www.acog.org) and look for their recommendations concerning induction and cesareans. The World Health Organization has recommendations too. The United States Department of Health and Human Services puts out a Healthy People document every 10 years that lists the objectives regarding health for the following 10 years. The reduction of the cesarean rate has been on it since 1990, at least (that would be the Healthy People objectives for 2000). These recommendations by prominent health organizations supports the belief that elective cesareans are detrimental, otherwise there would be no need (other than financial) to reduce the rates.

This is all info I got from my childbirth educator materials. Good luck!

Excellent post; thank you!

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this sounds along the same lines as the documentary by ricki lake, "the business of being born" or something like that.

Great eye-opening documentary! I highly recommend it...

I'm a doula in a medium size city in the midwest. Recently I had a lady call me to ask if I could help her with a VBAC. I said yes, that I'd done several of those. Later on in the conversation, she told me that it was a VBAC after 2 c-sections in which she had never labored. For her first baby, the doctor was so highly conservative. He diagnosed very slight tachycardia on one of her visits. Since she was pregnant, she wasn't able to go through testing to find out more info. The doctor ordered her to have a c-section w/o a trial of labor. Her second birth was a c-section only because her first birth was a c-section. Now, she wants to have a VBAC after 2 c-sections, and she's never labored. She is having one heck of a time finding a doctor who will take her. She called me to see if I could help her, but she lives 3 hours away from here. She said that she found a doctor whose nurse said that he'd do a VBAC after c-section X2, and I know this doc, I don't have a lot of faith in him to keep his word, and the hospital he delivers at does not do VBACs at all per policy. What he's essentially said to her, "Yeah, I'll do the c-section..." but he's going to drop it in her lap when it's too late to change to find ANY doc in this area who will do a VBAC, that the hospital's policy does not do VBACs.

This make me a little upset, mostly for her. If she had gotten a second opinion on the cardiac problem from a cardiologist, not an obstetrician, then they could have possibly made some allowances for her to have a vag delivery, and then the second c-section would probably have been unnecessary. But now, she's going for her 3rd with a hopeful longshot VBAC, and I don't see how she's going to do it. I feel so badly for her. She's called around out-of-state to find someone who would be willing to do a VBAC, and three states won't touch the VBAC with her conditions with a ten foot pole.

If she had done a little investigating the first time, she may have avoided the first c-section, and not be in the place she's in now. I just pray she's able to get some help. This has gotten me so curious, I might start a new thread....

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It's crazy, one of the women at my sister's job had her c-section date picked out, and she was only 3 months pregnant!

There was a story on the news about two months ago about this and how it's really shifting a lot to the patients themselves and not the doctors, even though the doctors are allowing them to do it. One woman said "why would I want to spend hours in labor when they can just numb you and an hour later you're holding your little one?". I'm not in maternity yet, planning to get in when I graduate, but do people not realize that a c-section is still surgery? It's not like pulling a tooth. My sister had an emergency c-section and she said the pain afterward was the most pain she had ever felt and it lasted for days because of the staples. And I watched her, coughing with a pillow in front of her, trying to get up and walk. She said she wished she would have been able to do it lady partslly.

When I get a paper in my nursing class where we have to choose a subject, this will definetely be the one that I'm choosing.

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I think joint commission is monitoring elective delivery and cesarean section this year (2010). They are part of the Perinatal Care Core Measure Set.

You can go to the joint commission website (jointcommission.org) for further info.

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Specializes in Critical care.

I'm 24 weeks with a boy and have a date scheduled for an "elective" c-section.

I say "elective" because my OBGYN doesn't do VBACs. My first son was born via c-section for what I am told was CPD. I was 40w5d when I was basically told by the CNM I needed an induction to "get things moving." This induction went on for 30 hrs, my water broke and then a bunch of people rushed into my room. I guess he had decels, my doctor says it's time for a c-section, I was so exhausted and scared I agreed.

I am interested in trying a VBAC but I feel stuck because only a few other doctors at my hospital do them. I'm stuck at my hospital since I have the insurance there and it would be big $$ to go out of network, and the doctors that do the VBACs I don't trust. I'd like to think I will go into labor on my own this time but am scared since I am small and my first baby was big this one would get into distress.

But yeah, back on topic, I do find myself rolling my eyes at people who want an elective section at the earliest possible time. Why take the risk? One of my husband's cousin's wives "demanded" a c-section because in her culture it was considered a more proper way to give birth. She's from somewhere in S. America, I didn't hear that first hand, but what I found most amusing was that the baby's father was an OBGYN himself! He didn't try to talk her out of it.

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Specializes in Cardiac.

I hate hearing women who want an induction because their doctor will be out of town over their due date. One girl I know " well he has been with us this whole time..I'd really like him to deliver.." Really?! The doc will be there a whole 5 minutes catching the baby..

Or another one "well at 35 weeks the doc said she's already 5 lbs so in 5 MORE weeks she'll be huge! So I'm having a C-section at 37 weeks..."

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