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Inducing Labor for Convenience, not Safety

August 14, 2007

The Los Angeles Times has a lengthy piece today on the induction of labor, a controversial practice that may not be medically necessary nearly as often as it is performed. The reporter indicates:

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.

Some seem to put the blame for unnecessary inductions on women, saying, “People want to schedule their birth like they schedule their nail appointments,” and regarding one hospital that has tightened their induction guidelines, “Hospital administrators no longer see sudden spikes in deliveries before major holidays, three-day weekends and Jazz basketball playoff games.”

The assumption seems to be that unnecessary inductions are all being performed at the women’s request. However, what I’ve heard from the women I know who have given birth recently is that they were told, “If you’re not in labor by X (despite due dates being estimates and being variable), we’re inducing.” I’d be interested in knowing just how many women actually asked for an induction with no suggestion from their providers, and why it was granted if there was no medical need. Induction is thought to increase the risk of complications, including the need for c-section.

A midwife interviewed for the story hits on this point, that physicians may actually be suggesting induction to women who don’t realize it’s not necessary.

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.”

 

But, she says, “once you do an intervention, it begets more interventions, and many women feel they are led down a road they didn’t understand. Women tell me, ‘I didn’t know it was going to end up like this.’ Women need to be given all the information on what they are signing up for, not just told, ‘You’re going to have your baby today.‘ “

One physician is also skeptical of recent research suggesting that induction does not cause complications when conducted appropriately.

“This is another study saying to women, ‘You can’t survive without us making things better; nature is completely off-track,’ ” says Klein. “And there is a huge reservoir of practitioners out there who want to hear this message.”

There are several studies referenced in the article; I try to dig those up and have more information later in the week.

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11 Comments leave one →
  1. August 14, 2007 6:20 pm

    You know, the more I read stories like this, the more I thank the Lord for infertility and adoption.

    Hopefully, my daughter will educate herself enough to know the difference between medical neccessity and the need to make an 11:00 tee time.

  2. August 14, 2007 9:19 pm

    My doula friend was at a birth just last month. The doctor called and yelled at the mom and hung up on her when she didn’t want pitocin (which is augmentation, not induction, but very similar and many times they are grouped together.) The doctor told her he had to cover two other OB practices that weekend, and he would really like to get her birth over with that evening. She caved and got the pitocin, which made her labor a painful roller coaster, so she got pain meds. (This woman wanted a “natural” birth.) She delivered in one hour. Not only was it not medically indicated, but it led to a precipitous birth.

  3. August 15, 2007 6:59 am

    Slarti, I love that you’re interested in having your daughter educates herself on these issues, and I hope things change some before she ever has to worry about it.
    Hilary, see, that’s exactly what I’m talking about, and I wonder how docs code instances like that. Would that be put down as an “elective” induction? “Would really like to get her birth over with that evening” – things like that are exactly why I think these birth issues are as important in terms of choice as abortion and contraception – the lack of respect for the woman, her body, and her child in that instance is astounding.

  4. snikta permalink
    August 15, 2007 8:41 am

    Chloe’s birth (and the pregnancy) were kind of a nightmare. Our OB was (and still is, from what I hear) horrible. Unfortunately, we were basically kids at the time, and didn’t know better. We only saw her a couple of times at our appointments. She was a total bitch at delivery. She induced labor, but was not even at the hospital until the birth. We went to hospital at 6am, J was hooked up at about 7, and Chloe was born at 11:35pm. The doc never came by (or called that I can remember), and she was called at about 9pm, then grudgingly came to the hospital at about 10 or 10:30. There was no prenatal discussion of birthing options. I could go on and on. I’m pleased with our current doc.

    BTW- we had an ultrasound, and pics are on Facebook.

  5. August 15, 2007 8:45 am

    Snikta, sorry to hear that, although it’s unfortunately common. It’s hard to feel like you’re really being cared for or getting your money’s worth in that situation. Will check out the pics. Come up with a name yet? Do let me know if either of you have any questions that you’d like me to look into.

  6. Hildy permalink
    August 17, 2007 7:09 pm

    I read Nicholson’s AMOR-IPAT paper; it’s an interesting approach. Conventional wisdom has been to induce somewhere in the 41st week due to stillbirth and foetal distress rates being much higher if pregnancy is carried beyond 42 weeks. The results are promising, although a proper RCT is necessary.

  7. August 18, 2007 9:54 am

    Hildy, haven’t seen it yet, but thanks for the recommendation.

  8. Nicole permalink
    February 19, 2008 2:53 am

    My midwife actually offered inducing my labor at 39 weeks although there is no reason medically for it. I didn’t ask but once she told me and I did some research I decided to do it.

  9. Alan permalink
    December 21, 2010 6:55 pm

    My sister was induced at her doctor’s suggestion 5 days before Christmas 6 years and one of my co-workers was just induced at her doctor’s suggestion 5 days before Christmas. What do you think is going on?

    Actually, when I told a doctor friend of mine about my sister, he told me they are pushing for it so they can have an uninterrupted holiday.

    I can’t blame them for wanting to be with their families, but the dishonesty, the pressuring and increased risks are completely irresponsible.

    If anything, I hope this makes more people question what their doctors tell them. Too many people switch off their thinking caps when in the presence of authority figures.

  10. A strong woman permalink
    January 2, 2012 2:32 am

    I agree with your comments. My OB tried to scare my husband and I last week to induce me. He said that it will be better to induce my labor 3 days before my due date without any medical reason just because in general, according to some statistics the baby after 39 weeks is ready and if she stays longer the higher the risk that she could die. All of my tests have come out “excellent” and I had no complications throughout my pregnancy. Another Dr looked at my tests and told me that I had nothing to worry about and if I didn’t want to be induced I didn’t have to. I feel betrayed by my Dr. I feel he just wants to induce me for 8 hrs the night before to fit his morning schedule the next day at the hospital. How convenient!
    I prefer a natural birth and since this is my first baby I am not going to let anyone pressure me. First comes the health of my baby and mine.
    I feel that the Dr was very unethical and I feel very dissapointed with his behavior. I trusted him and I was vulnerable because I believed everything he said to the point that I was very afraid. Now after another Dr consultation and further research I realize I am right and I have the right to decide how my baby should come to this world. I feel confident, calm and I am not going to let him fool me. Mother nature knows best!
    I hope other women read this post and stand strong like I am now. Just waiting for my baby to come when she is ready.

  11. February 16, 2012 5:17 am

    I recently was induced due to the convenience of my doctors schedule and rooms. It ended up in an emergency c-section. I was only 39 weeks at the time and there was no risk to the baby at the time of the induction. I was skeptical about the induction and scared that morning when I went in. However when the first nurse checked she said I was already dialated 3 cm so the induction would just push labor along. When my doctor actually came to check me after they had already started the medicine he said I wasn’t even a cm yet. I don’t believe inductions should be done for convenience and that all women should be more educated on when an induction is necessary instead of just trusting there doctors and nurses opinions. Wheather they want you to or not should not be the basis of you having an induction. It still is your body and there is always a risk of emergency ceaserean with induction. A fact that most doctors and nurses do not share with there patients until its too late. I was told this about half way thru the induction when I was already almost 6 cm.

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