OBs doing unnecessary C-Sections and inductions

[a_wallace4]

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.

[Erin, RN]

hello! last semester i completed a presentation on this topic for my graduate nursing research course based on the following questions:

do pregnant women in the u.s. whose labor is electively induced have a higher rate of cesarean delivery than pregnant women whose labor spontaneously begins? if so, are these women subjected to additional health risks as a result (i.e. increased risk for infection, increased risk for bleeding, and prolonged recovery periods)?

there's not a whole lot of quality, recent research from the u.s. available on this topic, but here are the 4 main journal articles that i reviewed. none of them were an experimental design, likely due to the ethics involved, but otherwise they seemed pretty quality.

dublin, s., lydon-rochelle, m., kaplan, r., watts, h., & critchlow, c. (2000). maternal and neonatal outcomes after induction of labor without an identified indication. american journal of obstetrics and gynecology, 183(4), 986-994, doi: 10.1067/mob.[phone]

--this article evaluated the relationship of elective induction of labor on maternal/neonatal outcomes, including method of delivery.

hoffman, m., vahratian, a., sciscione, a., troendle, j., & zhang, j. (2006). comparison of labor progression between induced and noninduced multiparous women. obstetrics and gynecology, 107(5), 1029-1034. doi: 10.1097/01.aog.0000210528.32940.c6

---this study compared labor progression in multiparous women who were electively induced (with or without cervical ripening) and those who spontaneously entered labor.

lydon-rochelle, m., holt, v., martin, d., & easterling, d. (2000). association between method of delivery and maternal rehospitalization. the journal of the american medical association, 283(18), 2411-2416. doi: 10.1001/jama.283.18.2411

---looked at rates of rehospitalization and postpartum complications based on method of delivery

wilson, b. (2007). assessing the effects of age, gestation, socioeconomic status, and ethnicity on labor inductions. journal of nursing scholarship, 39(3), 208-213.

---evaluated how induction of labor in primips and multips affected cesarean rate based on certain factors (i.e. maternal age, race, education level)

then just some fyi things that i ran across during my research....

birnbaum, c. (2009). what doctors don't tell you about c-sections. health (time inc. health), 23(9), 122-125.

caughey, a., sundaram, v., kaimal, a., gienger, a., cheng, y., mcdonald, k., shaffer, b., owens, d., and bravata, d. (2009). systematic review: elective induction of labor versus expectant management of pregnancy. annals of internal medicine, 151(4), 252-263.

---^ not limited to u.s. studies ^

childbirth connection. (2010). why does the cesarean rate keep going up? retrieved from http://www.childbirthconnection

.org/pdf.asp?pdfdownload=rising-cesarean-section-rate

latham, s., & norwitz, e. (2009). ethics and "cesarean delivery on maternal demand." seminars in perinatology, 33, 405-409. doi: 10.1053/j.semperi.2009.07.009

moleti, c. (2009). trends and controversies in labor inductions. the american journal of maternal/child nursing, 34(1), 40-47.

i have access to online journal databases because of school, but i think you can find the full text on a lot of these sources just through a yahoo search. hope this helps!!!

[LDRNMOMMY, BSN, RN]

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...

I had to check your profile to see if you worked where I worked in the U.S. since there was an OB that used the Kiwi with just about every single delivery. He also is in a speed competition with himself in the OR. I used to hate circulating his sections he could be in and out in less than 30 min. It's not the same doc, maybe they went to med school together since you are one state away from where I used to live.

I worked at a military hospital up until a few months ago and the difference was amazing! The induction protocol is just like the one mentioned a few posts back, no elective inductions before 39 weeks, etc. I LOVED that job and hope that I can find another unit like it when we move back to the U.S. later this year.

[ragingmomster, BSN, MSN, RN]

hmmm,

I wonder if I could just run an informal survey at work about how many of our elective inductions end up being c/s?

Anyone have any guesses or info about your unit?

[Elvish, BSN, DNP, RN, NP]

I think I am really lucky, we don't do that many social inductions. So few that I don't think I'd even be able to hazard a guess.

Most of our inductions are post-dates (which I realize can be controversial too) or for elevated BPs. Personally, as long my placenta is doing what she's supposed to, I wouldn't want a post-dates induction either.