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.

Specializes in L&D, PP, Nursery.
We have two docs in my hospital, and older, seasoned doc and a younger doc. Well the older doc rarely does c-sections/inductions, but our younger doc does them ALL the time, as soon as they get to 38 weeks, he talks inductions, and he'll blame it on "maternal discomfort". It drives us NUTS. We joke that he wants a 9-5 job, if you arent delivered by 5, you get sectioned. One of my coworkers has an article, I think she found it from a newspaper though about elective inductions. I had my two kids at a large tertiary care center and they did NOT do inductions/sections unless you had a medical reason, which is how it should be.

Do I know you? You must work with me! LOL

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Where are you from?

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Specializes in L&D, PP, Nursery.
Where are you from?

I was just kidding, but we do have a doc that does c-sections before dinner time also. He will section a prime that had her induction started only a few hours earlier for "dysfunctional labor" if it gets close to dinner time. God forbid if he'd have to come in during the night. It's been addressed over and over again but nothing seems to be done about it. By the way, I'm in PA

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Specializes in L&D.

The hospital I work at (around 8.000 deliveries/yr) recently revamped their induction protocol for this very reason (too many uneccesary inductions) and this was nurse driven and evidence based. We now require that all inductions complete 39 weeks AND have a proven medical indication or they don't get scheduled period. Of course there are those that are induced before 39 weeks if mom or baby are in danger. Although we still get the occasional bogus induction, this change in protocol has cut these down tremendously.

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Specializes in L&D.
I was just kidding, but we do have a doc that does c-sections before dinner time also. He will section a prime that had her induction started only a few hours earlier for "dysfunctional labor" if it gets close to dinner time. God forbid if he'd have to come in during the night. It's been addressed over and over again but nothing seems to be done about it. By the way, I'm in PA

Do you have a peer-review committee for doctors...I would suggest keeping the medical record numbers of this physicians' patients who have the "dinner-time c-sections" and bring it before such a committee for review. Sometimes we nurses can huff and puff as much as we want, but until other DOCTORS complain, nothing is done.

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I strongly recommend you get your hands on this article http://www.midwiferytoday.com/articles/UnneCesareans.asp from this past winter's Midwifery Today. It has some great info in it with extensive citations. I don't have it in front of me so I'll probably get this wrong, but I remember an example about a retrospective analysis of some hospitals' records showed that 2/3 of "emergency" sections take place between 9am and 3pm Monday through Thursday or something ridiculous like that. I bet you'll get some really good leads from the article's bibliography.

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Specializes in NICU,MB,Lact.Consultant, L/D.
The hospital I work at (around 8.000 deliveries/yr) recently revamped their induction protocol for this very reason (too many uneccesary inductions) and this was nurse driven and evidence based. We now require that all inductions complete 39 weeks AND have a proven medical indication or they don't get scheduled period. Of course there are those that are induced before 39 weeks if mom or baby are in danger. Although we still get the occasional bogus induction, this change in protocol has cut these down tremendously.

This is exactly the way it is where I work as well.

PS We do about 1800 deliveries a year

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Specializes in Aged Care, Midwifery, Palliative Care.

I also have some references from articles for your study.

We had a great Obstetrician give lectures just last week about induction and the risks. Ofcourse if there is a medical reason for the induction then the benefits will outweigh the risks, but if its just for convenience then the woman should be aware of her increased risks of CS and other interventions.

From Article 'safe healthy birth: what every woman needs to know'

Increased risks in healthy women with normal pregnancies more common with inductions:

Vacuum or forceps assisted lady partsl birth - instrumental delivery

Caesarean section

Fever,

FHR changes, shoulder dystocia, low birth weights and admission to NICU

Increased length of hospital stay

Inducing labour almost doubles the chance of CS.

Cascade of Interventions

Induced contractions often peak sooner and remain intense longer than natural contractions which may increase the need for strong pain medication

Caughey, A. B., Sundaram, V., Kaimal, A. J., Gienger, A., Cheng, Y. W., McDonald, K. M., ...Bravata, D. M. (2009). Systematic Review: Elective Induction of Labor Versus Expectant Management of Pregnancy. Annals of Internal Medicine, 151, 252-263.

Moleti, C. A. (2009). Trends and Controversies in Labor Induction. The American Journal of Maternal/Child Nursing, 34(1), 40-47. Doi: 10.1097/01/NMC.0000343864.49366.66

Lothian, J. A. (2009). Safe, Healthy Birth: What every woman needs to know [electronic version]. Journal of Perinatal Education, 18(3), 48-54. from PubMed.

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Specializes in Emergency, Trauma, Critical Care.

It's good to hear that OB nurses are concerned about this.

I can understand medically necessary ones.

I am probably going to have a scheduled c-section whether I want one or not. I have a VSD, they're expressing concern of possible CHF later in pregnancy, add all my abdominal scars from anal atresia/colostomy/and reversal of colostomy. We will see.

But to do all these elective ones? I have recently joined a pregnancy forum and the amount of women out there who just want "convenience" is insane to me. One girl asked if anyone thought they would let her just schedule a c-section so her lady parts wouldn't be loose after????

Yeah, because the possible infection from a c-section is much healthier....the possible complications...cmon now.

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Specializes in Geriatrics, L&D, Medsurg, Mom/Baby.
thank you everyone for your advice and links. i will have to post my paper when it is all finished. i think that it is ridiculous that so many women now a days get the choice when their babies are born. my cousin got to pick when her son was born and thought it was the coolest thing and guess what, her baby was born too soon. to jennf83 i wonder if this is a trend in younger doctors or if older doctors do it just as much. it's something i will have to find out. once again thank you everybody!

where i work- it doesnt seem to be an older vs younger ob thing. we have an older ob who accepts medicaid patients and the trend with him is to section 90% of the medicaid patients for one reason or another. he sets a record for the fastest section. in and out in 40 minutes or less. (he actually uses forceps during all sections)

he has already lost practices at one local hospital... why he has the ability to work for ours is questionable. then we have another ob who should do sections, but instead chooses to rip the woman half to pieces by using the vacuum more than it is indicated for use. when we have a woman with a 4th degree we typically always know who the ob was, before we are even told. it's disgusting what some ob's get away with...

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Specializes in Geriatrics, L&D, Medsurg, Mom/Baby.
http://www.medscape.com/viewarticle/587794
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It's disgusting what some OB's get away with...

Yeah, especially since if they did that any other time, they'd be in jail for assault, rape, attempted murder, etc. Makes me so mad. I'm all for women taking control of their births and laboring as their body wants to, and only helping if it's clear she's having an issue.

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