To Induce or Not to Induce? The Ethical Dilemma of Elective Induction
Let’s paint a picture. A 32-year-old patient gravida 1, para 0 presents at 38 weeks gestation and states that she would like to be induced the following day for personal reasons. She has not previous medical history which indicates that she is a high-risk pregnancy. She is electing to be induced.
Labor induction is the use of medications or other methods to stimulate contractions in the uterus to result in vaginal birth before labor has started on its own (). It can be a recommended if either the mother or fetus are at risk but sometimes, labor can be induced for nonmedical reasons and scheduled by the patient. Evidence suggests that there are no benefits to either mother or baby, however, there are several risks associated with inducing labor. These include but are not limited to infection in the mother and/or the baby, uterine rupture, increased risk of cesarean birth and death of the baby ().
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There has been a dramatic incline in the number of elective induced labors in the United States. Statistics show that there has been an increase in induced labor from 9.4% of births in 1990 to 23.2% in 2009 (). These increased rates can especially be seen among non-Hispanic White women with private or commercial insurance and more than 12 years of education (). While this increase alone is of significant concern, studies show an increase in induced labor during the preterm period, including the late preterm period between 34 through 36 weeks of gestation. This is especially alarming as this could have significant negative impacts on the infants overall development and health ().
Our profession calls for dedication to nursing excellence through ethics, standards and best practice. Specifically, labor and delivery nurses as well as midwives are known for providing compassionate care and advocating for women to be actively involved in all aspects of their care. They have the responsibility of playing the delicate role of balancing each individual’s right to birth as they desire while at the same time advocating to provide evidence-based practice levels of care and improving maternal and child birth outcomes.
Therein lies the ethical conflict: how do you provide care that reflects the birthing parent’s unique needs (elective induction) while at the same time providing care that does not put birthing parent and/or baby at increased risk for negative outcomes.
Some would argue that ethically, the birthing parent has autonomy over her body and should be able to decide the what, where, when and how around all medical procedures. While I do not disagree with this, we cannot risk the chance of violating other ethical values like nonmaleficence and beneficene because of autonomy.
It is important that we fall back on the ethical principles and theories that shape our practice as nurses in order to make a decision that is ethically sound. Our primary responsibility and commitment, as stated by the first and second provisions of the ANA code of ethics are that we practice with compassion and respect for the inherent dignity, worth and unique attributes of every person and our primary commitment is to our patient ().
This includes providing patients with all the education they need. Research shows that 78% of women who elected to induce labor felt confident that they were knowledgeable about the procedure, however on further inquiry it was found that they in fact were not aware ().
I firmly believe that it is our role and duty as nurses to provide care to each individual following the lines of what would make them most comfortable. In the same light, it is our role and duty as nurses to keep up to date on evidence based practice in order to provide up to date information to our patients and advocate for them. We walk the fine ethical line all the time and bear the load of providing the absolute best care to our patients by finding a balance between both patient desires and evidence based practice.
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We cannot let egoism play a role here by only considering that which is evidence-based care while ignoring the wishes of the birthing parent. However, tapping into the ethical theory of utilitarianism, we must look at all the benefits and risks involved. and together with the people involved make a decision that is best suitable for the birthing mother and baby.
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