Summary

The federal government, through the Department of Health, Education, and Welfare (HEW), has a number of responsibilities relating to obstetric practices, including: (1) ensuring the safety and effectiveness of drugs and medical devices; (2) funding medical research and Professional Standards Review Organizations; (3) educating the public on health care; and (4) paying for deliveries under some federally funded programs. Critics maintain that hazards are associated with the following obstetric practices: (1) elective induction of labor; (2) the use of medication to relieve labor pain; (3) the preventive use of forceps; (4) routine electronic fetal monitoring; and (5) the increasing use of caesarean sections.

HEW has taken some actions regarding obstetric practices, such as the safety and efficacy of some drugs used in obstetrics. HEW recommended that labels of drugs used for induction contain a warning stating that the benefit versus risk ratio for elective induction of labor has not been defined, and the recommendation was also made that two drugs used for induction of labor be removed from the market. Although HEW has a system for collecting information on adverse drug reactions, it has no system for periodically reviewing marketed drugs. HEW has sponsored little research on obstetric practices. Except for evaluations of the use of caesarean sections, Professional Standards Review Organizations have done few medical care evaluations on obstetric practices.