It started as a little joke. Sherry Martin of Tennessee was almost at the end of her fourth pregnancy  -- and the end of the year  -- when she made a lighthearted comment to her obstetrician. "I told him my husband said he might not get paid if he didn't get the baby here before New Year's so we could get a tax deduction," says Martin (whose name has been changed). That's not a problem, her doctor told her. He suggested that he could induce labor on her due date  -- December 31  -- and be perfectly justified in doing so, since her third child had been nine and a half pounds and he wanted to avoid another big baby. "At the hospital, doctors have to give a medical reason to induce," says Martin, "so my reason was that I tend to have big babies."

When the day came, Martin, who'd never been induced before, hesitated. "I thought, 'This is crazy. Why am I doing this?' But I was tired of being pregnant, and it was such a good time, with the kids out of school on Christmas break. You can definitely control things much better when you do an induction."

Martin went to the hospital and was hooked up to an IV of Pitocin, a drug that's often used to bring on labor. Six hours later, she delivered a healthy seven-pound girl. She says she never worried that anything would go wrong with the delivery because she was never told of any potential risks, such as an increased chance of fetal distress, c-section, and, though rare, uterine rupture, which can be fatal to the baby or mother. "I might not have done it if I'd known the risks," she says now.

Sherry Martin is part of a growing number of women who are having inductions, some for medical reasons, some not. The rate of induced births has not only doubled in the past ten years  -- to almost 18 percent of all deliveries, according to the National Center for Health Statistics  -- but there's also a trend toward outright promotion of elective inductions, those done mainly for the doctors', or parents', convenience.

Elective inductions increased 15-fold from 1980 to 1995, according to a study by Barbara Yawn, M.D., director of research at the Olmsted Medical Center, in Rochester, MN. "Scientifically speaking, no more than ten percent of birthing women should be induced," says Marsden Wagner, M.D., former director of women's and children's health for the World Health Organization. "What this means is that our rate is almost double what it should be. That's something to be very concerned about." According to Dr. Wagner, the rates of induction in other highly industrialized countries, such as England and Sweden, are between five and ten percent of births.

In a study published in the American Journal of Obstetrics and Gynecology, induction rates were more than twice as high for patients at private hospitals as for those at government-owned hospitals. They were also higher for mothers with some college education and those with private insurance, as opposed to Medicaid.

At the Chicago obstetrics practice of Lauren Streicher, M.D., for example, almost 50 percent of her patients are induced. "Patients come to us because they know we're okay with a more controlled situation." She says her clients are affluent women who tend to want to be in charge of things a little more  -- their return to work, childcare for their other kids. "They have more of a relationship with their physician," she adds, "and there's more of an emphasis that they want 'Dr. X' to deliver."

Dr. Streicher is a firm believer in elective inductions; she says that when the baby's head is in the pelvis and the cervix is ready  -- soft and sufficiently effaced and dilated  -- inducing is no more dangerous than spontaneous labor. "It's natural for some women to want to control this process as much as possible," she says, noting that she won't do an induction before a woman is 39 weeks along, for fear of delivering a baby who's not mature enough.

Other doctors claim that such attitudes are behind the boom in inductions and present a threat to women and their babies. "The procedure should never, ever, be done if the risk of induction is higher than the risk of staying pregnant," says Charles Lockwood, M.D., chair of the committee on obstetrical practices for the American College of Gynecologists and Obstetricians (ACOG), which officially discourages elective inductions.

"The body is not a machine; you can't just punch in numbers and it will deliver a baby," says Robbie Davis-Floyd, Ph.D., an anthropologist at the University of Texas who specializes in the study of birth and medicine. "I believe childbirth should not be overmedicalized and that, in most cases, the body knows best."

Dr. Streicher dismisses this notion. "If the body knew best, there wouldn't be stillbirths or preterm births," she says, pointing out that nature can make mistakes in any circumstance. "It's okay to give the body a push, as long as you're careful."

Jeannie Ralston is a contributing editor to Parenting.

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