|
Consortium
for the Evidence-based practice of Obstetrics --
C.E.O. is dedicated to bringing science-based
maternity care to all childbearing women
|
|
Quotes
and Excerpts from www.eObGynNews.com
and
other respected sources of professional information
on safety, complications & practice trends for obstetricians
|
Bibliography, Recommended Reading and Scientific
Citation from obstetrical sources for the:
Medicalizing Normal Childbirth
Has
the Medicalisation of Childbirth Gone Too Far?
BMJ 2002;324:892-895 (13 April)
Richard Johanson, professor of obstetrics a, Mary Newburn, head of policy research b, Alison Macfarlane, professor of perinatal health c.
Promoting Evidence-based practice in
maternal care –
would keep the knife
away;
BMJ Vol 324 20 April 2002;
Childbirth, Pregnancy tied to PTSD,
Experts say,
Ob.Gyn.News; Mar 15 2003 Vol 38, No 6
Excerpts
from “Adverse Perinatal Outcomes”;
Association of Women's Health,
Obstetrical and Neonatal Nurses Journal (AWHONN) June| July 2003
Delayed consequences for baby
of Narcotic Use in labor
Promoting
Evidence-based practice in
maternal care – would keep the knife away; Editorial -- BMJ Vol 324 20 April 2002;
In
maternal health care, their is a recognized gap between evidence of effectiveness
and clinical practice. Indeed, too often routine care is not
evidence-based and there is a strong resistance to stopping harmful or useless
procedures. Unnecessary caecarean section and
episiotomy are good examples of
the mismatch between evidence and practice and of the complexities that change
entails as two articles in this issue illustrates.
Unnecessary
caecarean is known to increase health risks for both mother and newborn child
and adds burdens to healthcare budgets. There has been a sustained growth in
caesarean sections rates worldwide....
Contrary
to anecdotal evidence that portrays Brazil as a place where women demand
caesarean section, two recent articles show that providers, rather than
patients, use women's alleged preference as an excuse to follow their
inclination.
Informed
choice is central to good quality care. Unfortunate, mother's decisions on
obstetric procedures are too often anything but true exercises of free
will:
woman receive incomplete information, they voice their "preferences"
while experiencing severe stress and pain, and (especially in developing
countries) the social gap between patient and provider curbs their
decision-making power.
To
achieve goals of providing women and families with the opportunity to become
active players in their own healthy care, charges will have to occur. Firstly,
technical quality and interaction between patients and professionals will have
to improve; this includes explicitly offering women the chance to make informed
health related decision using effective instruments
which is itself is a
challenge.
.....while
we
continue to discuss unnecessary interventions, millions of women that require
these procedures do not have access to them and
risk their own and their
children's lives.
Childbirth, Pregnancy tied to PTSD,
Experts say, Ob.Gyn.News; Mar 15 2003 Vol 38, No 6
Pregnancy
and childbirth should added to the last of risk factors for posttraumatic stress
disorder and diagnostic code for traumatic childbirth should be created...
"Every
obstetrician .... has seen patients with posttraumatic stress disorder related
to pregnancy and childbirth, but physician recognition of PTSD--- in all
patients, including women who have had difficult births--is still
low.
Women
who have traumatic births may not be able to fully articulate the event later
on.
The
literature on PTSD and pregnancy and childbirth is scant and mostly from
Europe. "The Europeans are ahead of us and have been looking at what
happens after birth in women," she said.
“Adverse Perinatal Outcomes”;
Excerpts // Kathleen Rice Simpson, PhD, RNC, FAAN & G. Eric Knox, MD
Association of Women's Health,
Obstetrical and Neonatal Nurses Journal (AWHONN) June| July 2003
[This
is an excerpt from a 9-page article in the AWHONN journal that drew on records
of malpractice litigation as example of 'preventable' deaths or damage that
are a result of systemic problems in medical care. What follows are simply the
description of two such cases of "iatrogenic' (doctor-caused) or
nosocomial (hospital employee cased) complications.]
Production
Pressure: Haste Makes Waste
Elective
Induction of Labor -- After the unit's daily limit of four elective labor
induction was filled, a physician requested admission of another women for
elective induction. The unit's three nurses were caring for the four women being
inducted plus another women in spontaneous labor.
The
physician was informed that his patient would have to wait until there were
enough nurses available to safely care for his patient. The physician called the
nurse manager and demanded that his patient be admitted because of
"decreased fetal movement" that had "developed" after the
original request was refused. The nurse manager told the nurses to do what they
could to accommodate the physician to begin the induction.
The
nurses argued for an immediate non-stress test and induction later that
afternoon when staff were going to be available, but were overruled by the
nurse-manager and the physician. ..... The admission process occurred over 35
minutes during which the other five patients were being cared for by two nurses.
A patient of another physician
had an fetal heart rate bradycardia lasting 25
minutes in the 60s secondary to uterine hysperstimulation and hypertonus
[complication of induction in which the uterus dramatically over-reacts to the
Pitocin] Terbutaline .25 mg [a drug that counteracts the affects of
Pitocin] was administered by subcutaneous injection and an emergent Cesarean
birth was performed 27 minutes after the FHT bradycardia was noted. The baby was
born depressed with Apgar scores of 3 at one minute and 4 at five minutes.
Umbilical artery cord pH was 6.86 with a base excess of -17. The baby
developed cerebral palsy.
A
jury held the institution responsible for inadequte maternal-fetal assessment during
oxytocin administration.
Pressure,
Speed and Impacted Shoulders -- A woman was completely dilated at
2:10pm.
The physician was called for impending birth and arrived at 2:30 pm. On
examination the fetal head was noted to be at +2 station. An
office full of
patients was waiting; the physician did not feel there was time to wait for
spontaneous fetal decent. He asked the nurse for
fundal pressure while he
applied forceps. She reluctantly agreed and the fetal head was brought down to
+4 station with forceps and fundal pressure. The head was delivered at 2:35
pm,
but shoulder but shoulder dystocia occurred. Eight minutes later the fetal body
was delivered.
The
baby was non-responsive at birth with Apgar scores of 0-1-3. The baby suffered
neurologic damage and developed cerebral palsy. During the litigation process,
it was discovered that fundal pressure was routinely used at this hospital to
shorten the second stage of labor for convenience.
Up to this time there had
been only reports of minor injuries to several mother and babies but no
significant adverse outcomes. The liability claim was settled prior to trial
for 5.6 million with each paying half.
Discussion:
Production Pressure
The
fundamental issue facing every organization is the constant tension between
production and protection. Under most circumstances, an organization leans
toward production at the expense of safety for two reasons (Reason, 1997).
First, those who manage organization are trained in, develop and possess
production rather than safety skills.
Whether implicitly understood
or not an important task of nurse and physicians is a continuous series of
choices between production and safety. ....
Production
pressure and miscommunication, as illustrated in the preceding two stories, are
two of the most
important factors that contribute to and are the cause of loss
of situational awareness, an important cause of medical accidents and patient
harm.
Photographic Sampler of Medicalized Labor
& Normal Childbirth as a “Surgical Procedure”