The L.A. Times has an excellent article about the practice of inducing labor, which has been on the rise for the last twenty or so years. Apparently, for a variety of reasons, some hospitals have been trying to control this trend.
Some hospitals and healthcare organizations across the nation share her concerns. Several have barred elective labor induction under certain circumstances, such as before 39 weeks of gestation (one week before the due date) or when there isn’t clear evidence that the mother’s cervix is primed for childbirth.
“There is renewed interest in these seemingly benign medical interventions,” says Dr. William Grobman, an assistant professor of maternal-fetal medicine at Northwestern University. “But the topic is somewhat hazy. We don’t have all the information we’d like to have about risks and benefits.”
The move appears to be a push back against the trend in recent decades to medically manage childbirth. Fewer than 10% of women underwent induction in 1990, but more than 21% did so in 2004, according to federal government statistics. No one knows how many of those inductions were prompted by legitimate medical concerns. But various studies have put the number of inductions for convenience at 15% to 55% of the total number.
At the same time, rates of caesarean sections increased to more than 29% in 2004, up from 23% in 1990, with many women requesting elective C-sections — surgical births without any medical justification. That trend too has generated debate about whether patients are undertaking unnecessary risks.
Labor induction is frequently, and legitimately, recommended when health problems complicate a pregnancy or when pregnancies are more than two weeks past the due date, obstetricians and gynecologists say. But sometimes the procedure is done solely for convenience. In a busy society, doctors and patients have grown increasingly comfortable with this practice.
“People want to schedule their birth like they schedule their nail appointments,” says Janie Wilson, director of nursing operations for women and newborns at Intermountain Healthcare, a Salt Lake City-based chain of hospitals that has tried to reduce the rate of labor inductions.
In my opinion, there are two underlying issues here. One is money and the other is the notion that some people are treating childbirth as a medical procedure rather than a spiritual and philosophical process by which babies come into the world.
There is little scientific evidence that labor induction causes any long-lasting harm to mother or baby. But even short-term medical problems are significant given the nation’s healthcare economics crisis, Wilson says. According to Intermountain’s data, healthy deliveries in the 39th week (and women whose cervixes were fully prepared) incur the lowest costs.
“It could be contributing to the double-digit premium increases you pay each year,” she says of elective labor induction’s effect on insurance rates. “Cost is the icing on the cake. But it’s not the main reason we should be doing this. We should do it because it’s safer.”
The argument that natural labor is safer, though, is in much dispute. The article does a pretty good job surveying the two sides. But here are a couple choice quotes about the lifestyle implications of inducing labor which seems to be offending some people.
Hospital administrators no longer see sudden spikes in deliveries before major holidays, three-day weekends and Jazz basketball playoff games.
“This is another study saying to women, ‘You can’t survive without us making things better; nature is completely off-track,’ ” says [Dr. Michael C. Klein, emeritus professor of family practice and pediatrics at the University of British Columbia.] “And there is a huge reservoir of practitioners out there who want to hear this message.”
“I’m not sure consumers think about the risks. They think, ‘Gosh, I want elective induction at 38 weeks because I’m tired of being pregnant,’ ” she says. “Hopefully, educating them up front and setting expectations will make it easier.”
Doctors who want the convenience to schedule daytime deliveries may be the biggest force for elective labor induction, says Lisa Sherwood, a certified nurse midwife and women’s healthcare nurse-practitioner based in San Clemente. Women who “haven’t slept well in weeks, have swollen ankles and sore backs” are vulnerable to the suggestion of elective induction. “People look at the doctor as the expert and will do whatever he or she suggests.”
So it’s not just the women who want to schedule child-birth at convenient times. Some doctors seem to be pushing for labor induction too.
Still this is not a simple issue. There are a confluence of factors that seem to be informing people’s views: money, safety, and lifestyles. The least important part of that, in my mind, is money. Sure something rubs me the wrong way about a doctor who would prefer to schedule a labor induction procedure around his playoff basketball watching schedule but one would assume informed consent of the patient is still required, right?
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