Upcoming Stillbirth Conference in Minnesota
Dr. Nicholson has been invited to present at the upcoming Star Legacy Foundation’s Stillbirth Summit 2014, 19-21 June, in Medina (Minneapolis), MN. This Summit is a major educational and networking event expected to draw more than 200 interdisciplinary professionals, advocates and families. Presenters will share innovative research in stillbirth prevention and perinatal bereavement. This 3-day Summit includes two days of clinical presentations and discussions followed by one day of bereavement presentations and discussions.
Presenters will address issues related to the four key areas of the Summit’s theme, Stillbirth Prevention: Identifying and Protecting the Vulnerable Baby:
- Stillbirth Awareness & Advocacy
- Stillbirth Prevention
- Stillbirth Risk Identification & Management
- Perinatal Bereavement
Dr. Nicholson’s discussion topic is titled: “Beneficence, Autonomy and the Ethics of the Current Restrictions on Early Term “Non-Indicated” Labor Induction.” The 39-week rule was instituted in 2009-2010 and basically states that “non-indicated” delivery (labor induction or cesarean delivery) should not occur prior to 39 weeks 0 days of gestation. The 39-week rule is currently enforced throughout the USA in a variety of ways.
The talk will begin by focusing on the fact that the current restrictions on pre-39 week “non-indicated” labor induction are not based on high-quality research. In contrast, a recent review of high-quality research (i.e., evidence from randomized clinical trials) concludes that term labor induction, as compared to expectant management, is more beneficial rather than harmful. Specifically, non-indicated labor induction leads to lower C/S rates, lower NICU admission rates, and decreases the rate of fetal death by 50%). These effects occur irrespective of gestational age, cervical Bishops score and parity (See: Mishanina et al. 2014).
As a result, the ethical principle of “beneficence” cannot be used to support the restriction of “non-indicated” term labor induction. Next the talk will consider the fact that pregnant women at term often request labor induction for a variety of reasons that do not meet the definition of an “indication” (See: ACOG Practice Bulletin No. 107: Induction of Labor).
The ethical principle of “autonomy” suggests that patients – provided they have an understanding of the risks and benefits of any given medical treatment – should be able to request (or to refuse) that medical treatment. The current situation, where the request by a patient to have a “non-indicated” labor induction is restricted/not-allowed in most hospital settings, is therefore difficult to justify from an ethical perspective.
Finally, because there is some evidence that the rate of term stillbirth has increased in the USA since 2010 (i.e., when the 39-week rule was instituted), the talk will consider the possibility that the current “39-week rule” may have very important negative consequences and should be either modified or discarded.
The inter-disciplinary audience for the Summit will include physicians, midwives, nurses, social workers, therapists, clergy, diagnostic sonographers, researchers, program administrators, parents and parent advocates, families, and policy experts.