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Ethical issues in childbirth.

A E Laslie
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Abstract

Medical intervention in childbirth raises a number of ethical issues which have received too little attention in American obstetrics. A number of these issues are surveyed in the first section of this essay. In the second section, the hospital and the roles characteristically ascribed to patients, staff, and obstetrical practitioners are shown to provide an unsatisfactory social setting for birth. Several proposals for improving existing arrangements or for providing alternatives are offered. It is argued that procedures for eliciting and maintaining fidelity to patient values for the birth experience are crucial elements in acceptable care.

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Delivery, ObstetricEthics, MedicalFamilyFemaleHumansMother-Child RelationsObstetricsObstetrics and Gynecology Department, HospitalPatient AdvocacyPregnancyPregnant PeopleResearchRisk AssessmentSocial ValuesUnited StatesProfessional Patient RelationshipJournal Article

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BibTeXRIS

A E Laslie. 1982. Ethical issues in childbirth.. https://doi.org/10.1093/jmp%2F7.2.179

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Effects of teamwork training on adverse outcomes and process of care in labor and delivery: a randomized controlled trial.

OBJECTIVE: To evaluate the effect of teamwork training on the occurrence of adverse outcomes and process of care in labor and delivery. METHODS: A cluster-randomized controlled trial was conducted at seven intervention and eight control hospitals. The intervention was a standardized teamwork training curriculum based on crew resource management that emphasized communication and team structure. The primary outcome was the proportion of deliveries at 20 weeks or more of gestation in which one or more adverse maternal or neonatal outcomes or both occurred (Adverse Outcome Index). Additional outcomes included 11 clinical process measures. RESULTS: A total of 1,307 personnel were trained and 28,536 deliveries analyzed. At baseline, there were no differences in demographic or delivery characteristics between the groups. The mean Adverse Outcome Index prevalence was similar in the control and intervention groups, both at baseline and after implementation of teamwork training (9.4% versus 9.0% and 7.2% versus 8.3%, respectively). The intracluster correlation coefficient was 0.015, with a resultant wide confidence interval for the difference in mean Adverse Outcome Index between groups (-5.6% to 3.2%). One process measure, the time from the decision to perform an immediate cesarean delivery to the incision, differed significantly after team training (33.3 minutes versus 21.2 minutes, P=.03). CONCLUSION: Training, as was conducted and implemented, did not transfer to a detectable impact in this study. The Adverse Outcome Index could be an important tool for comparing obstetric outcomes within and between institutions to help guide quality improvement. CLINICAL TRIAL REGISTRATION: (www.ClinicalTrials.gov), NCT00381056 LEVEL OF EVIDENCE: I.

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