New induction policy a threat to women, or a threat to doctors? You be the judge.

An article in The Newcastle Herald yesterday states that:

pushing a policy to reduce caesarean births are creating rules that are potentially dangerous for patients and threatening to doctors ... red tape is threatening professional independence.

It also discouraged treatment tailored to individual patients.

... Compliance with directives telling obstetricians when and how to deliver babies was mandatory, under the threat of disciplinary action and loss of indemnity cover ...

... a recent directive requiring a reduction in caesarean section rates to 20per cent by 2015 was an illusory and possibly dangerous target.

What is being referred to here is the NSW Health Policy Directive on induction of labour at or beyond term. It is a well-written and thorough document that can inform best practice for induction of labour. Rather than "telling obstetricians when and how to deliver babies", it guides practice in a woman-centered manner:

Induction of labour carries inherent risk and must be exercised with caution. There needs to be clear benefits for the mother and/or the fetus.

At term, women must be offered information about the risks associated with prolonged pregnancies, and the options available to them.

Induced labour has an impact on the birth experience for women. Labour is often more painful than spontaneous labour, and epidural analgesia and assisted delivery are more likely to be required. Treatment and care should take into account a woman’s individual needs and preferences. Women who are having, or being offered, induction of labour must have the opportunity to receive accurate information and make informed decisions about their care and treatment, in partnership with their health care professionals.

This doesn't sound like an approach that is potentially dangerous for patients or an approach that discourages treatment that is tailored to individual patients.

The article goes on to assert that:

Also concerning was a departmental policy that elective or pre-labour caesarean section must not routinely be carried out before 39weeks gestation, due to risk of respiratory morbidity in babies.

And the problem is? All this is saying is that an elective or pre-labour caesarean should not routinely be carried out before 39 weeks. This is not the same as saying that caesarean can never be performed prior to 39 weeks, yet the contributors to the article go on to say that:

‘‘[The policy] effectively forbids doctors in NSW public hospitals to schedule routine elective caesarean section before 39weeks,’’ ...‘‘Anyone doing so risks disciplinary action and may forfeit indemnity cover.’’

This is clearly nonsense!

The policy directive does state that:

Induction of labour must not routinely be offered on maternal request alone.

Health care professionals offering induction of labour must: • provide the woman with adequate time to discuss the information with her partner/support person before coming to a decision; • encourage the woman to access a variety of sources of information; • invite the woman to ask questions, and encourage her to think about her options; and • support the woman in whatever decision she makes.

Women should be offered support and analgesia as required, and staff should encourage women to use their own coping strategies for pain relief. This includes the opportunity to labour in water.

I fail to understand what is unreasonable about this policy which is evidence-based, woman-centered and flexible so as to meet the woman's present health needs. Most health professionals practice within evidence-based guidelines, best practice guidelines and accepted standards of practice. These are developed in consultation with industry experts and after consultation of the relevant literature on the subject. I am curious that the obstetricians in this article are critical of a policy directive that is based on evidence and safe practice, citing that such a policy would threaten professional independence. RANZCOG has policies and guidelines, as does the UK Royal College of Obstetricians and Gynaecologists. A mark of a professional body is that it possesses its own information that is unique to the profession. Why has this new policy directive caused such concern for doctors? It is merely suggesting that women should not be induced willy-nilly for no good reason and we have good evidence to justify this position.

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