24h-payday

NPR’s Beginnings Series Warns of the Risks of Elective Induction

A recent All Things Considered story that aired as a part of NPR’s Beginnings series discussed concerns over elective labor inductions and the movement by some doctors to decrease this trend in our country’s maternity care system.  From the news piece, Doctors to Pregnant Women:  Wait at Least 39 Weeks:

“Statistics show that from 1990 to 2006 the percentage of women who induced labor more than doubled, and nearly a third of women were having cesareans.” (--narrator)

“…It’s now really well-documented in national studies that the risk of the baby having to require intensive care in a neonatal intensive care unit — even the risk of infant death — is increased when the baby is born as little as two weeks before the due date,” says [Ed Donovan, pediatrician at Cincinnati’s Children’s Hospital].”

Later in the story the narrator, Gretchen Kuda Croen, goes on to explain that our nation’s labor induction rate is also hovering around 30%–a statistic that is surely well-known by Science & Sensibility readers.  To me, the two non-coincidentally identical statistics—30% labor inductions and a 30% cesarean rate*—make a glaring statement: when we try to force childbirth to occur when mom and/or baby are not yet ready, that induction is not going to work.  And, in the case of elective induction: rather than admit to this error in timing, hold our horses and let mom go home, inviting labor to start on its own on a different day, we dig in our heals, allow our own personal agendas to take over, and we end up pushing far beyond the option of a vaginal birth, and head straight to the operative suite–setting mom up for a longer and, in most cases, more difficult post-birth recovery.

And let me tell you, I don’t speak from a lofty pedestal here:  I speak from experience.  Eight years ago, my husband and I scheduled an elective induction for our first born at 38 1/2 weeks.

Thankfully for our family, everything went well:  our daughter was born healthy and strong with no cause to be admitted to the NICU.  But just because our story was uneventful, I don’t turn a blind eye to what practitioners like Jay Iams, a specialist in maternal fetal medicine at Ohio State University, are reporting.   A couple of years and plenty of education later, I came to understand the risks we had taken when we opted to electively induce the birth of our daughter “for social reasons” (we were due to move out of state two weeks after the baby’s due date).

Several doctors and medical facilities from Ohio, which are featured in this story, are touting the great achievements they are making in reducing their elective induction rates—along with their NICU admission numbers.  I would love to see this trend replicated in hospitals all over the country.  Better yet, I would love to know that women are sharing the news on this issue with other women: that labor induction for convenience sake constitutes a big gamble in terms of their child’s health and well-being.  I applaud NPR not only for broadcasting this story, but for taking on the entire Beginnings series.  To listen to more stories in this series, go here.  To read about what is being covered in this summer-long series, go here.

Other stories in this series:

Drug Given to Moms After Childbirth Sparks Controversy (misoprostol)

In Mozambique, A Fight To Keep Babies HIV-Free

In Mozambique, Grim Prospects For Mother And Child

Group Prenatal Care: Finding Strength In Numbers

A Prenatal Surgery For Spina Bifida Comes Of Age

Love It Or Hate It, Pregnancy ‘Bible’ Has A Lot To Say

Rethinking SIDS: Many Deaths No Longer A Mystery

 

 

*some studies quote rates as high as 34%

 

 

Posted by:  Kimmelin Hull, PA, LCCE

 

 

 

Medical Interventions, News about Pregnancy, Patient Advocacy, Pre-term Birth , , , , , , ,

  1. avatar
    Lamaze Educator
    July 28th, 2011 at 08:53 | #1

    While most of this series has been really good, (Thankfully) I missed the piece last week about SIDS. Talk about incorrectly beating the old dead horse. Yes, unsafe sleep conditions happen, but I wish they would talk about 2 main reasons for SIDS: Cigarette smoke exposure and formula feeding. I also get furious that they neglect to add that sleeping with baby in a couch or a chair is very, very dangerous place for a baby to sleep–which seems to get glossed over. I’m not saying the back to sleep campaign stuff is without merits, but the message needs to be expanded to really inform parents. As an educator, if I just talked about the ABCs as mentioned in this piece, I would not be giving parents the correct information. They need to know about all of factors that contribute to this tragedy, not a simple acronym.

  2. avatar
    Ariann
    July 28th, 2011 at 08:58 | #2

    I’m really perplexed by elective induction. Is this not simply malpractice? Why would a doctor ever agree to this knowing the increased risk of C-section involved and the danger to the baby of being born too early? Doctors say no to elective procedures all the time if the health risk outweighs the potential health benefits or if the patient does not seem psychologically or medically ready. Why is induction different?

  3. avatar
    Kimberly
    July 28th, 2011 at 14:43 | #3

    Please don’t confuse correlation with causation. Just because as inductions go up so do c-sections does NOT mean they are connected. Yes there is a relationship there, but you canNOT rule out other possible factors.

    For example, in the summer ice cream sales go up. So do violent crimes. Does that mean ice cream causes crime? NO! Obviously not. The same thing could apply here. It’s tantalizing to say one causes the other, but you cannot demand that obstetrics be evidence based whilst quoting bad statistics. It makes the natural birth movement look like a bunch of ignorant, poorly educated idiots.

    I do think there is a relationship between induction and c-section but we can’t PROVE it. And not all inductions end in c-sections. My husband and I were both induced babies. His mom had a c-section in the end. Mine didn’t.

    Besides I think perhaps the overall attitude in obstetrics is what causes those bad numbers. Fighting induction won’t necessarily lead to less c-sections without a HUGE change in practicing doctor’s attitudes and hospital policies.

  4. July 28th, 2011 at 16:42 | #4

    @Kimberly
    From the study, Impact of Labor Induction, Gestational Age, and Maternal Age on Cesarean Delivery Rates, published in the Green Journal August 2003 – Volume 102 – Issue 2 – p 287–293:

    “In nulliparas, labor induction was associated with an increase in cesarean delivery from 13.7% to 24.7% (adjusted odds ratio [OR] 1.70; 95% confidence interval [CI] 1.48, 1.95]).”

  5. avatar
    Lamaze Educator
    July 28th, 2011 at 17:46 | #5

    Especially, you must consider that a lack of progress (which can happen when the body was not ready for an induction) is a reason for a cesarean. If AROM was involved and mother’s cervix doesn’t change, she can’t go home. Guess what she gets?

    A cesarean.

    So yes, as Kimmelin pointed out with the citation, there is causation.

  6. July 29th, 2011 at 10:52 | #6

    I agree that the reasons for medical induction are getting more and more outrageous. Post maturity carries certain risks – that’s a given – but, with careful monitoring, most of these risks are minimized. However, fear-based medicine wins out every time. Induced labour is often very painful, and women do not have the opportunty to acclimatise to contractions.
    I will induce labours using acupuncture – mostly with great success – but, only when there is a clear 2 weeks past EDD. Trouble is, many women are not being ‘allowed’ to get that far and more often than not I am asked to induce before then. This poses a dilemma, as it means my delivering a service that I am not professionally comfortable with. Not doing so, however, means the mother has to go through a chemical induction – which the both of us want to avoid.
    Women have a choice but, it can only be exercised if they have been given honest, accurate information that is rooted in the best interests of her and her baby, and not in the egos of practitioners.

  7. July 29th, 2011 at 11:44 | #7

    Do you find that stimulating the same points with acupressure is as effective as stimulating them via acupuncture for labor induction (when labor induction is actually favorable?)

  8. avatar
    Kimberly
    July 29th, 2011 at 12:07 | #8

    Thanks Kimmelin-why didn’t you put that in the blog post to begin with? It would make your argument much stronger.

  1. No trackbacks yet.