In Many Cases, A Patient Increases Their Odds Of A Cesarean

The author is a nurse in a level two trauma facility in a community of approximately fifty thousand people in Oregon. The community is a college-town surrounded by a large agricultural area. There is a minimal ethnic diversity within the community. The diversity present occurs mainly from internationally students and faculty from the college. There is a growing population of women who desire low interventional births in the community. The author has worked on the labor and delivery unit of the hospital for the last 14 years. The hospital is the only one in the area to offer trial of labor services to women who have previously undergone a cesarean section. The unit on average experiences around 1000 deliveries annually.

The significance that this mother did not receive prenatal care is that the risks for having a premature delivery could have been reduced or eliminated completely. The mother could have been put on medications to stop early labor like Magnesium sulfate to relax the smooth muscle of the uterus and stop contractions, progesterone to prevent early labor, and monitoring fetal heart rate patterns in order to report any complications to the attending provider caring for the patient. Progesterone reduces the risk of delivering a baby early, before 37 weeks gestation, in mothers who are pregnant with just a single fetus or a mother who previously had a premature birth of a fetus (Progesterone Treatment, 2014, para. 4). In

The writer explained there could be no concern for fetal or maternal health during the delivery although some obstetricians tended to induce labor in all diabetic mothers to protect babies and mothers. Moreover, labor progress was supposedly assessed by old-fashioned methods, which resulted in performing unnecessary obstetrical practices. Intervention was imposed in cases of inaccurately labeled slow or abnormal labors and failures to progress. It is common practice that a primary cesarean generally produces subsequent surgical deliveries. The author realized that cesareans were performed because of insufficient data on laboring women’s

Shah then goes on to state how cesarean surgeries may be beneficial, or may not be beneficial to the mother, but are most likely unbeneficial to the newborn, unless there is a serious threat. Shah states, “ … that those born by cesarean were significantly more likely to develop chronic immune disorders.” of which he acquired from a Danish study from two million children born at full term. In contrast Dr.Shah states how many of his patients benefit from his surgeries, even though he stated previously how dangerous they were, and how he gets to save lives and bring new ones into the world. Finally, Shahs closing remarks are on how to fix the overuse of C-sections. Shah states how natural birth is the preferred way to go and that cesarean surgeries should be only for emergency use only and not for choice. In addition, Dr.Shah goes on to say how a perfect way to fix the overuse is to take the “British way” and to “...stay away from obstetricians altogether - at least until you need

A catalyst for unplanned cesarean deliveries are inappropriate elective inductions. Being that the direct consequence of inappropriate elective induction is a cesarean delivery, a change must occur in the elective induction process. In order to decrease cesarean delivery rates, the rates of inappropriate elective induction must be decreased. This

Randomization was used to generate what patient went to which group. The way the patients were chosen eliminated bias because “Randomization was performed according to a computer-generated list by means of sequentially numbered, opaque, sealed envelopes which revealed the allocation of the subject to either induction or expectant management”(Nielsen et al. p. 60). This secure randomization added a great strength to the study. The sample size seemed fairly large, 226 patients were split into 116 for elective induction and 110 to expectant management, although the power analysis was disclosed in this study and determined that 600 patients were required. Only 226 patients were used and because it would take 4 years to reach the required amount of patients, the study was discontinued. This was both a strength and weakness because disclosing this information made the study more honest but the quota needed to reach the best answers was not attained. The study for the 226 patients was pretty standard with the 80% power and alpha at 0.05. T-test and chi square tests were used to compare the proportions between the groups of people. The women were chosen based on the inclusion criteria of being 39 weeks gestation or older, maternal age of more than 17, fetal cephalic presentation, singleton gestation, a candidate for vaginal delivery, and a Bishop score of 5 or greater in nulliparous women and 4 or greater for multiparous women. This inclusion criterion was a concern because both nulliparous women and multiparous women were being tested together. This was a weakness because the labor patterns of a nulliparous woman compared to a multiparous woman are very variable and sure to distort study data. It was also disclosed how gestational age was achieved which included the crown rump test measured in 6-12

An argument for the case of minimal medicalized intervention during birth can be made in terms of low-risk pregnancies and reserving medical interventions for high-risk deliveries and emergency situations. The purpose of this paper is to ensure that members of the childbearing community, including healthcare professionals, are familiar with alternative interventions to cesarean section and thoroughly consider the risks and benefits of said interventions so that natural child-birthing methods can be promoted in low-risk situations.

Critique of Borders et al.’s Study (2013) “Midwives’ Verbal Support of Nulliparous Women in Second-Stage Labor”

The model of care I observed at the hospital was the patient centered care model. The nurses worked with the patients, typically on a one-to-one nurse-patient ratio. The nurse helped and tended to the patient’s needs, drew her blood, inserted a catheter, and watched the monitors on the baby to ensure everything was going smoothly. It surprised me that a number of the patients I saw were being induced, and according to the nurses, a lot of patients have planned C-Sections. The two soon-to-be mothers that I encountered in the labor and delivery area were being induced. The first one was in the middle of the induction, and she had Pitocin already infusing when I got there, so her contractions were getting stronger. When she needed to use

Some reasons that this induction or c-section may be done would include; Abruptio placentae, gestational hypertension, fetal demise, preeclampsia, pre mature rupture of membranes, as well as conditions with the mother or with the fetus inside.

“In the United States, approximately 25,000 births (0.6%) per year occur in the home. Approximately one fourth of these births are unplanned or unattended. Among women who originally intend to give birth in a hospital or those who make no provisions for professional care during childbirth, subsequent unplanned home births are associated with high rates of perinatal and neonatal mortality. The relative risk versus benefit of a planned home birth, however, remains the subject of current debate” (American College of Obstetricians and Gynecologists).

The rate of cesarean deliveries (CD) has risen 48% in the United States since 1996. In the US, the total percentage of women who deliver their babies via cesarean section is 32.7%, which is more than double what the World Health Organization recommends. WHO suggests that 10% to15% is medically necessary (Almendrala, 2015). There is a large variance of cesarean rates among ethnic groups, and studying these communities can possibly help us identify the reasons for these discrepancies. Nationally, Native Americans have a low percentage of cesarean sections (Leeman, 2003). In Oklahoma, 34.3% of Native American women have Cesarean deliveries. The number of CDs by Native American women specifically in Oklahoma County is slightly less than the

Vaginal birth after caesarean (VBAC) is the name used for identifying the method of giving birth vaginally after previously delivering at least one baby through a caesarean section (CS). A trial of labour (TOL) is the term used to describe the process of attempting a VBAC. An elected repeat caesarean (ERC) is the other option for women who have had a caesarean in the past. The rates of women choosing to deliver by means of an ERC has been increasing in many countries, this is typically due to the common assumption that there are too many risks for the baby and mother (Knight, Gurol-Urganci, Van Der Meulen, Mahmood, Richmond, Dougall, & Cromwell, 2013). The success rate of VBAC lies in the range of 56 - 80%, a reasonably high success rate, however, the repeat caesarean birth rate has increased to 83% in Australia (Knight et al., 2013). It is essential to inform women of the contraindications, success criteria, risks, benefits, information on uterine rupture and the role of the midwife in relation to considering attempting a VBAC (Hayman, 2014). This information forms the basis of an antenatal class (Appendix 1) that provides the necessary information to women who are considering attempting a VBAC and can therefore enable them to make their own decision regarding the mode of birth.

Besides medical reasons, there could be many non-medical explanations of the recent rise in cesarean deliveries. Perhaps, due to rise in childbearing age women are simply at higher risk of developing childbirth-associated complications than the women were 25-30 years ago. However, difference in hospital-level CS rates among low-risk women which essentially illustrates that maternal health status alone cannot account for the CS (Radha et al., 2015; Neuman et al., 2014). In some context, convenience factors and the threat of medical malpractice lawsuits create incentives for providers to choose cesareans over vaginal delivery (Mishra & Ramanathan, 2002). Evidences from India and elsewhere documented CS among women who had no reported or diagnosed pregnancy complications (Mishra & Ramanathan, 2002; Shabnam, ????)

Culturally and traditionally, a woman has always delivery her baby through the vagina, unless there was a medical emergency that requires a caesarean section. There are many controversies as to why women should and should not get a caesarean, and one of the controversies is choice; the mother should be able to choose her method of delivery. The idea that a woman can choose the way she delivers can be very empowering and enriching. If a woman can choose to have an abortion, why can’t they choose their method of delivery (Steel, 2015)? Also, to some women, a caesarean section can be more predictable because they know what is going to happen once they get on the surgical table so its consider more predictable in some respects to vaginal birth,