Two stories about cesarean deliveries or C-sections, which are increasingly prevalent in the United States, recently made the news.
* Nurses employed by Hospital Corporation of America (HCA) have been authorized to begin preparations for emergency cesarean deliveries without a physician's order. By giving nurses this responsibility, the hospital system aims to keep the time between admission and start of procedure to 30 minutes or less, which would meet current practice standards and reduce the hospital's malpractice liability risk.
* An HCA study found that many procedures fail to meet the 30-minute standard because of an inability to get the team together quickly and an inconsistent definition of "emergency." By allowing nurses to initiate preparations, HCA has reduced the number of procedures that begin after the 30-minute deadline by nearly two-thirds.
* An independent panel formed by the National Institutes of Health couldn't find sufficient evidence to recommend for or against cesarean deliveries performed at the mother's request without any medical indication for the procedure. But the panel did recommend that women who request a cesarean delivery receive counseling about the benefits and drawbacks. The panel also recommended against elective cesarean deliveries for women who want large families (because risks in subsequent pregnancies increase with each cesarean delivery) and against cesarean delivery before the 39th week of pregnancy or without verification that the baby's lungs have matured. Full text of the panel's findings is available at http://consensus.nih.gov.