The medical sections and health care are essential to any country. Generally speaking, the citizen’s life mostly relies on how efficient and effective the medical fields and health care are managed. Until recently, the healthcare industry is facing a lot of ethical dilemmas particularly in the area of defensive medicine. Essentially, defensive medicine refers to medical practices that may absolve physicians and doctors from liability without substantial benefit to patients (Sethi, Natividad, Obremskey, & Jahangir, 2012). In this regard, this paper seeks to examine why vaginal delivery is the best option following the case study by highlighting its many advantages over its disadvantages. Further, the paper will outline the aspects of cesarean delivery and its weaknesses to show why vaginal birth is suitable.
Case Study Analysis
According to the case study, the Chief financial officer (CFO) faces an ethical dilemma of allowing the practice of defensive medicine or putting a stop to it altogether. Looking at the matter from a business side, the hospital and the physician receive a higher compensation amount for performing a cesarean birth. Nonetheless, according to an article by California HealthCare Foundation (2011), cesarean births increase the potential for heightened rates of surgical infections, complications, as well as increase risks in future pregnancies. Therefore, if I was in this particular situation, I would encourage physicians to focus more on performing vaginal delivery as it has few risks and, available research shows that many women prefer this delivery method (Nahed, Babu, Smith & Heary, 2012). On the other hand, cesarean delivery should only be performed if there are medically necessary reasons or in situations where the pregnant woman prefers a cesarean delivery. I believe that this is the best ethical decisions as health care professions should actively observe ethics and not focus entirely on the financial gains of performing a specific procedure.
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Vaginal Delivery
Notably, vaginal delivery is more suitable as there are low risks involved. In general, vaginal delivery is the birth of a baby via the vagina. Most experts recommend this type of delivery for pregnant women whose babies have reached full term which is nine months. This type of birth has some benefits (Hamai & Imanishi, 2011). First, although vaginal delivery is a long process that can be physically exhausting, it has a shorter recovery time and hospital stay compared with cesarean delivery. Even though the laws in every state are different, the primary length of a hospital stays for a woman after a vaginal delivery is between 24 and 48 hours.
Second, women who choose to undergo vaginal delivery avoid having crucial surgery and its related risks, for instance, scarring, severe bleeding, reactions to anesthesia, infections and more longer-lasting pain (Goetzinger & Macones, 2015). Additionally, a mother can hold her baby and even start breastfeeding immediately after delivery. Third, women develop a sense of accomplishment and empowerment after vaginal delivery. This is because they actively take part in the childbirth experience. They are required to push to assist in moving the infant via the birth canal and into the universe.
Fourthly, vaginal delivery has neonatal benefits as well. These benefits consist of physiological adaptation to the outside world relative to hematologic, respiratory, as well as immunologic systems. For this reason, there is a decrease in TTN, RDS, and respiratory-related NICU admissions. Further, there is fewer infections and conceivably enhanced immune function because it is connected to short and long-term allergic responses and bowel function.
Despite its benefits, there are some risks associated with vaginal delivery, particularly neonatal risks. These risks generally involve birth trauma, specifically shoulder dystocia and sequela. Complications in the newborn include asphyxia as a result of a delay in delivery or birth trauma form manipulations employed to deliver the baby (Sethi, Natividad, Obremskey, & Jahangir, 2012). In addition to neonatal risks, women can also die during vaginal delivery although the death rates are not as high as deaths due to cesarean delivery.
Cesarean Delivery
On the contrary, a cesarean delivery is the delivery of a newborn baby via incisions made in mother’s uterus and abdomen; it is sometimes referred to as a C-section. Generally, the procedure was introduced to save the lives of pregnant women and their newborns for life-threatening childbirth or pregnancy-related complications. However, there has seen a rapid rise in the rates of C-section globally in the past decades. The procedure has become so prevalent such that they are viewed as “normal births” in spite of the heightened risks (Begum et al., 2017). In most cases, physicians choose to perform cesarean deliveries mainly because they are concerned about avoidance of risk and medical liability, as well as particular labor practices, for example, increased dependency on labor induction, lack of patience in labor, and early labor admission (California HealthCare Foundation, 2011).
Disadvantages of a Cesarean Delivery
Even though a C-section can be a life-saving procedure, a cesarean delivery, at the same time, has many drawbacks. First, and more importantly, if a woman is pregnant for the first time and has a C-section delivery, the woman has a high likelihood of having a cesarean delivery in ensuing years. For example, in California, the majority of women who have a cesarean delivery for their first child often end up having a C-section for their subsequent deliveries (Neu & Rushing, 2011). It is imperative to note that undergoing multiple C-sections raises the chances for complications, such as life-threatening hemorrhage, as a result of problems associated with placental implantation. Second, babies born by C-section without scheduled labor contractions have a more likelihood of suffering from neonatal respiratory issues as compared to those born vaginally.
Third, the high cost of cesarean delivery may result in fatal health expenditure for families and add more pressure upon overburdened healthcare systems specifically in low and middle-income nations. It is no secret that cesarean delivery is very costly and some families may not be able to afford it. Thus, I believe that cesarean delivery should only be performed when medically necessary.
Fourth, available research shows that there is a delayed onset of lactation when one undergoes a C-section. Therefore, many children born by cesarean delivery lack the initial support of breast milk. Breast milk is vital to an infant as it acts as a stimulator for physiological intestinal flora. The late start of lactation may lead to long-lasting detrimental effects on the child such as impacting the initial biodiversity of intestinal bacteria.
Last but not least, cesarean deliveries may heighten the risk of maternal death specifically in low resource settings (Stockman, 2009). Thus, because of the previously mentioned risks, I would recommend that Cesarean delivery be performed only in cases of medical emergencies for example, during multiple pregnancies, where a woman is carrying more than one child. Again, the likelihood of having a C-section increases with the number of babies in the uterus.
Also, a cesarean delivery may be done if there is a failure of labor to advance where the contractions may fail to open the cervix enough for the fetus to move into the vagina. Additionally, a C-section may be done if there are issues with the placenta or there is a concern for the baby. For example, the umbilical cord may become compressed or pinched, or fetal monitoring may discover an irregular heart rate (Neu & Rushing, 2011). Further, the procedure may be performed if there are maternal infections, for instance, herpes or HIV (human immunodeficiency Virus). More so, maternal conditions such as high blood pressure or diabetes may demand a C-section to be done. Overall, the hospital should reduce the rate of cesarean delivery among low-risk women and, at the same time, women should be given a chance to choose their delivery option if there are no medical conditions or emergencies present regardless of the compensation received.
In conclusion, the paper has demonstrated why vaginal birth is the best delivery method by outlining its many advantages following the case study. Also, the risks associated with cesarean delivery have been thoroughly discussed. For the most part, healthcare professionals face a lot of ethical dilemmas particularly in the area of defensive medicine. Overall, physicians should focus on performing vaginal births if both the pregnant woman and the fetus are healthy. Cesarean delivery, on the contrary, should be performed for medically necessary reasons or in situations where the pregnant woman prefers a cesarean delivery. Therefore, because of the few risks associated with a vaginal delivery as compared to cesarean delivery, physicians should devote themselves to performing more vaginal births instead of the latter.
References
Begum, T., Rahman, A., Nababan, H., Hoque, D. M., Khan, A. F., Ali, T., & Anwar, I. (2017). Indications and determinants of caesarean section delivery: Evidence from a population-based study in Matlab, Bangladesh. Plos One, 12 (11). doi: 10.1371/journal.pone.0188074
Cesarean Births Continue to Rise. (2011, December 8). Retrieved April 12, 2018, from https://www.chcf.org/press-release/cesarean-births-continue-to-rise/
Goetzinger, K. R., & Macones, G. A. (2015). Operative vaginal delivery. Management of Labor and Delivery, 108-129. doi: 10.1002/9781118327241.ch6
Hamai, Y., & Imanishi, Y. (2011). Efforts to promote vaginal delivery after a previous cesarean section. Journal of Obstetrics and Gynaecology Research, 38 (1), 113-117. doi:10.1111/j.1447-0756.2011. 01630.x
Nahed, B. V., Babu, M. A., Smith, T. R., & Heary, R. F. (2012). Malpractice Liability and Defensive Medicine: A National Survey of Neurosurgeons. PLoS ONE, 7 (6). doi: 10.1371/journal.pone.0039237
Neu, J., & Rushing, J. (2011). Cesarean Versus Vaginal Delivery: Long-term Infant Outcomes and the Hygiene Hypothesis. Clinics in Perinatology, 38 (2), 321-331. doi: 10.1016/j.clp.2011.03.008
Sethi, M. K., Natividad, H., Obremskey, W., & Jahangir, A. A. (2012). Incidence and costs of defensive medicine among orthopedic surgeons in the United States: a national survey study. American journal of orthopedics , 69-73.
Stockman, J. (2009). Risk of respiratory morbidity in term infants delivered by elective caesarean section: Cohort study. Yearbook of Pediatrics, 2009 , 424-425. doi:10.1016/s0084-3954(08)79023-7
