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Discussion

preterm inductions

Hi all - I have a concern. I recently transferred to a sister hospital in our system. I LOVE LOVE LOVE it there and have worked in L and D for about a year. A new policy is supposedly pending in our system to prevent inductions before 38 weeks. (YAY!) unless medically indicated. Well where I work now the chief of OB is BIG into cutting and BIG into "she has PIH so we have to induce her" even though it is CLEAR that the patient does NOT have symptoms of PIH. All PIH labs normal, no s/s and maybe ONE elevated pressure. He may try a trial of labor and then say "well she isn't progressing.." even though she IS, and then end up cutting her. I am so disgusted by this doctor that I am now refusing to take his patients. I would love to write him up however no one has the guts to do it because he brings so much money into this hospital and he is the chief.. so not sure quite what to do. I am considering going to my director... Everyone knows he does this but how do you do anything about it? What would you do - honestly and truly.. what would you actually do.. not what you think you SHOULD do :) Thanks!

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    Contact the OB-GYN Board in your area, and ask them to investigate. They may do it without revealing their source.

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    evidence base practice. Check out keystone OB from MHA.

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    ACOG states that elective inductions should not be done until at least 39 weeks so measures to prevent inductions under 38 weeks are still not adequate. Even though this doc brings a lot of $$ to the hospital-one law suit could cost the hospital millions. I would bring it up to your nursing director. In my institution the ob commitee polices each other-any induction under 39 weeks is reviewed by the QCI committee for true medical need. There have been some cases of induction for "PIH" with nothing to support the diagnosis so the docs have all been warned that they are being watched-the inductions have become much more appropriate since then. Like I said before, even though he brings in a lot of money for the hospital, he still needs to practice according to accepted guidelines or he could be putting the hospital at risk.

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    One of the things that is so hot right now in my facility is "duty to report". Do you have a corporate intergrity hotline that you can report things to for breeches and such? You can report this kind of "stuff" to them and the hospital is bound( forced) to investigate. I have run across this situation many many times, and I bring those cases to our OB/GYN meetings and lay it all out. I discuss the supposed diagnosis and then try my hardest to find evidence to support it and when I can't, I ask the doctor to help me understand. JCAHO is watching this stuff. It won't be immediate, but I forsee elective inductions becoming a hot, hot issue in the coming years. ACOG simply needs to stop putting out rules and not enforcing them....

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