Repeat cesarean section and primary elective cesarean section: Recently trained obstetrician-gynecologist practice patterns and opinions
ABSTRACT This study was undertaken to determine opinions of obstetrician-gynecologists regarding vaginal birth after cesarean (VBAC) section and elective cesarean section.
A questionnaire was administered to obstetrician-gynecologists attending 2 review courses.
Of 500 obstetrician-gynecologists, 304 completed the survey for a response rate of 61%. Most (92%) counseled VBAC candidates differently, and 84% quoted differential VBAC completion rates on the basis of the indication for prior cesarean section. Uterine rupture was virtually always discussed (99%). Pelvic floor risks were infrequently discussed with urinary incontinence, pelvic organ prolapse, and fecal incontinence discussed by less than one third of obstetricians (30%, 28%, and 25%, respectively). Fifty-nine percent of physicians would perform a primary elective cesarean section, and 67% would perform a primary elective cesarean section specifically to prevent pelvic floor disorders.
Two thirds of recent graduates are willing to perform an elective cesarean section to prevent pelvic floor injury. Most offer VBAC; however, less than a third include risk of pelvic floor injury in their informed consent discussions.
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ABSTRACT: OBJECTIVE: To examine the role of the labor and delivery nurse in a nurse-managed practice model and nurses' perceived ability to influence decisions about mode of delivery and outcomes. DESIGN: Cross-sectional, descriptive, qualitative study. SETTING: One nurse-managed labor and delivery unit in a community-based hospital near a major metropolitan area. PARTICIPANTS: A purposeful sample of 13 registered nurses with intrapartum experience. METHODS: Qualitative, in-depth interview data were subjected to content analysis. RESULTS: Experienced labor and delivery nurses perceived their role to be influential in decisions about mode of delivery. Negotiating for more time was integral to the way nurses exerted their influence, allowing for the time needed to implement practices that promote vaginal delivery. Knowledge of labor and physician practice patterns shaped the specific communication strategies used by nurses in their roles as negotiators. CONCLUSIONS: The responses of experienced, intrapartum nurses to actual and perceived time pressures and the subsequent impact on nurse-physician communication patterns and delivery mode outcomes are significant. Findings indicate the need to further explore how individual nursing practice may function as an independent predictor of delivery mode and how shared decision making among physicians, laboring women, and nurses affects rates of cesarean delivery.Journal of Obstetric Gynecologic & Neonatal Nursing 11/2012; 42(1). DOI:10.1111/j.1552-6909.2012.01422.x · 1.20 Impact Factor
- Edited by UNIVERSIDAD DE GUADALAJARA, 01/2011; UNIVERSIDAD DE GUADALAJARA., ISBN: 978-607-450-393-7
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ABSTRACT: Whether practice differences exist between the sexes is a question of clinical and educational significance. The obstetrician-gynecologist (ob-gyn) workforce has been shifting to majority women. An examination of sex differences in ob-gyn practice contributes to the discussion about how the changing workforce may impact women's healthcare. We sought to review survey studies to assess whether there are specific topics in which differences in attitudes, opinions, and practice patterns between male and female ob-gyns are apparent. We conducted a systematic review to identify all survey studies of ob-gyns from the years 2002-2012. A total of 93 studies were reviewed to identify statements of sex differences and categorized by conceptual theme. Sex differences were identified in a number of areas. In general, women report more supportive attitudes toward abortion. A number of differences were identified with regard to workforce issues, such as women earning 23% less than their male counterparts as reported in 1 study and working an average of 4.1 fewer hours per week than men in another study. Men typically provide higher self-ratings than women in a number of areas. Other noted findings include men tending toward more pharmaceutical therapies and women making more referrals for medical conditions. Although a number of areas of difference were identified, the impact of such differences is yet to be determined. Additional research may help to clarify the reasons for such differences and their potential impact on patients.Obstetrical & gynecological survey 03/2013; 68(3):235-53. DOI:10.1097/OGX.0b013e318286f0aa · 2.36 Impact Factor