System Stakeholders and Primary Users

Localio, et al. (367) anchor that the diagnosis vagabond for these 19 clinical risk factors ranged from 0.1 percentage (uterine rupture) to 8.7 percent (dystocia). Localio, et al. (367) found that the overall rate for the presence of these risk factors was 4.4 percent. The rate of caesarian region pitching section deliveries in the unite States in 1965 was 4.5 percent (Placek, Taffel, and Moien 562-564). The rate of ces bean section deliveries in the United States in 1993 was 24.8 percent (Taffel, Clarke, Placek, Parrish, Holt, Connell, and Easterling 1829-1830). Comparisons of these data support the competition that a significant coincidence of cesarean section deliveries represent an ab subprogram of the surgical procedure.

The use of the cesarean section procedure does lead to improved outcomes for approximately complications of pregnancy, however, negative consequences are also associated with delivery by cesarean section (Fawcett, Tulman, and Spedden 253-259). Because of these anomalies, both about physicians and some women have conclude that cesarean sections generally occur in too some(prenominal) cases (Stafford 59-63). Flowing from this skepticism has been an increase in vaginal deliveries for women who previously had delivered through low-section cesareans, although the overall rate of cesarean section procedures has non dropped (Rates 2360). The rate of v

aginal delivery adjacent a prior cesarean delivery (referred to as VBAC or vaginal let after cesarean), however, increased from 3.4 percent in 1980 to 18.5 percent in 1989.Clinical factors are important considerations in some decisions to use cesarean section (Taffel, et al. 1829-1830). Clinical factors, however, do not appear to be the governing criteria in most much(prenominal) decisions (Faiola 2338-2339). One such nonclinical factor is the medical malpractice laws in the United States. Many physicians, it is contended, recommend cesarean section to patients as a defensive measure to head-off possible malpractice suits. The United States is a super litigious society, and physicians increasingly are sued by patients for monetary change when health care outcomes are unseemly.

Birth is a comparatively high risk activity. Many physicians believe that adverse outcomes associated with birth whitethorn be best controlled through cesarean section delivery (Localio, et al. 366-373). Recognizing that physicians have a legitimate interest in seeking to protect themselves from unjustified law suits, however, is quite different from accepting a contention that physicians are justified in steering women toward cesarean section delivery when the potential for an adverse delivery outcome is negligible. Physician behavior of this type may legitimately termed as an abuse of the counseling process.

Stafford, Randall S. "The Impact of Nonclinical Factors on Repeat Cesarean Section." Journal of the American Medical tie beam 2 January 1991, 59-63.

The evidence presented in this essay supports the contention that a majority of the cesarean section deliveries in the United States are not justified on the basis of relevant clinical factors, and that a substantial proportion of the decisions by women related to delivery procedure are made in conditions wherein relevant learning related to delivery alternatives have been withheld by physicians. These findings support the contention th
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