The threefold increase in the cesarean birth rate in the United States during the last ten years has caused much concern among the general public and some medical professionals. Nurses particularly have shared this concern as the scope of nursing practice has expanded and nurses increasingly see themselves as patient advocates. Obviously, not all cesarean births are unwarranted. The procedure may be indicated if there is maternal or fetal risk during labor, if attempted induction of labor fails, and/or if an emergency mandates immediate delivery which is not possible or suitable vaginally.

A recent review of over 1,000 U.S. and foreign research articles cites three general reasons for the increasing cesarean birth rate: use of the operation for breech presentations and for repeat sections; the need for early intervention due to fetal distress as determined by the increasing use of fetal monitoring; and physicians' fear of malpractice suits. The first two reasons are matters of medical controversy.

The medical-surgical instructor was appalled when she learned that one of her students had volunteered to perform a complex wound irrigation — a procedure in which the student was thus far untrained. Throughout the semester the student had required extra supervision and guidance, and despite this her performance had been marginal at best. Written assignments were disorganized, incomplete, and revealed poor grasp of theory, while clinical skills were consistently below acceptable levels.

But the instructor was even more appalled when other faculty members opposed her decision to give the student a failing clinical grade. “Too harsh,” they said. “Give the poor kid a break.” The instructor followed her own judgment and conscience and failed the student, but never received any support for her decision from the school's administration or faculty. Some time later, in talking with faculty from other schools, the instructor learned that her experience was not unique. Others had similar problems: resistance to failing and even not-so-subtle pressures to pass students whose performance the instructor deemed to be substandard.

The purpose of this column is not to teach you how to use the law library to perform legal research (something very few lawyers know how to do efficiently), but to give you enough information so that you can locate the legal materials cited in Nursing Law & Ethics. To locate most references cited in this newsletter, you will have to use a law library. The first rule of research in any unfamiliar library is, of course, to ask the reference librarian for assistance.

All law schools have substantial libraries, as do many local bar associations. To obtain admission to the law library of your local law school, you may need special permission from the school or the assistance of a law student. Once inside, you will discover the principal problem with writing about “the law” in the United States: each of the 50 states has its own court system and legislature, and therefore, each has its own set of statutes and case reporters. Superimposed on this structure is a system of federal district courts and federal appeals courts.