Scheduled Inductions Raise C-Section Rates: Should Hospitals Ban Them?
March 12, 2012
A study released this past February may cause antsy moms-to-be to think twice before scheduling induced labor for non-medical reasons, a now-common practice for pregnant women seeking convenience, or simply an end to the seemingly-endless third trimester. The report, which was compiled by Australian researchers and tracked the labors and deliveries of 28,000 women—some of whom went into spontaneous labor, while others were induced for either medical or non-medical reasons—documents a significant percentage increase in both C-section deliveries (67% increased risk—that’s big), and NICU care (64% increased risk), for women and their babies who undergo non-medically necessitated inductions.
Although the rate of such inductions has more than doubled over the past 20 years, many hospitals across the US have recently implemented policies refusing pregnant patients this option before they reach 39 weeks gestation. This trend is due in large part to studies like the Australian one, and others that indicate significant brain development taking place in babies right up through the 38th week of gestation. The Australian study, too, revealed that women giving birth after the 38th week run the lowest risk of labor complications, and—although spontaneous labor between 38 and 39 weeks seems to be the low-intervention statistical sweet-spot for moms and babies alike—women whose kiddos continue baking up through 41 weeks end up requiring fewer epidurals than women who deliver earlier do. (This surprised me, since those babies are bound to be bigger… who knew?). So while 39 weeks is predominantly where induction-banning hospitals have drawn the line—most of these hospitals do allow moms who’ve past that point to schedule inductions with their doctors if they choose to-- this recent study seems to indicate that spontaneous labor, whether at 38 or 41-plus weeks, is statistically ideal for everyone involved, in terms of necessary interventions.
Kaspar’s birth was induced—and I did receive an epidural (because Pitocin contractions are, like, literally off-the-charts intense)— at 39 weeks, I believe. My induction was deemed medically necessary long before I even approached that point, though; I’d been on blood thinners throughout my pregnancy due to having had a random, likely birth-control-induced blood clot during college (estrogen levels in pregnancy are way higher than birth control pills, so pregnancy put me at risk for another clot; blood thinners then reduced that risk). I’d read all about the benefits of intervention-free birth, for mom and baby, and I hoped to go into spontaneous labor before the scheduled induction, but that didn’t happen. When it came time to deliver, I was so excited to meet my baby—and yes, to be finished with pregnancy—that I did take my doctor’s advice and move ahead with the induction. I should mention that my obstetrician specialized in high-risk pregnancies and deliveries, and had a lower-than-average C-section rate on record (a good sign in New York, where hospitals are packed and both moms and doctors don’t shy away from planning every aspect of baby arrival for maximum efficiency). He also felt that I was the healthiest “high-risk” patient he’d ever had—as in, probably not so high-risk after all-- but that it doesn’t pay to play with fire… blood clots are no joke; he felt we should induce, according to the usual protocol for this particular type of health history. I agreed— and I didn’t look back. My delivery experience was awesome, and uncomplicated (although definitely medically facilitated) by all counts.I don't regret the induction.
That being said, if I do it again (and this is purely hypothetical; we’re actually kind of planning to adopt kidlet #2), assuming the pregnancy is as healthy as my pregnancy with Kaspar was, I’ll try to find a way around that induction. I’m pretty sure it wasn’t actually necessary, and I’d be willing to stab myself with blood thinners through 41 weeks gestation if that’s what it’ll take to go the distance. I was excited back when Kaspar was born, but I was also a first-timer, and thus, well, paranoid. Medical intervention felt more predictable and secure to me than letting nature do its thing (little did I know, nature does its thing best). I’d be a lot more confident in the whole pregnancy and delivery process for round two; I’ve done this before. I know that babies are a force of nature and that, in fact, medical intervention had little to do with my body growing a baby to birth-readiness. That’s the whole miracle, isn’t it? I mean yeah, sometimes medicine is also a miracle, and sometimes it makes all the difference in keeping moms and babies alive, but short of those extreme situations, I tend to think now—especially given the growing body of research around this stuff—that medical intervention should be reserved for (and definitely used in) emergencies… Or when a doctor believes it’s truly necessary for the well-being of a mom or baby, but not simply for convenience, comfort or peace of mind.
As a matter of sheer opinion, scheduling deliveries for convenience, in order to run hospitals more efficiently, or in order to guarantee a particular delivery team’s availability seems to me like a typically Western (controlling nature/maximizing profits) way of going about something that is fundamentally a life-changing human experience that hinges on—and is arguably made better by-- the element of surprise. We grow these babies for nine months, and we know they’re coming, but we don’t know exactly when. To approach that ‘when’ with a day planner in hand may appeal to doctors who’d rather stay home on Saturday nights, or to parents who want to plan their new-baby celebrations to a T, but that very sense of control and planning is misleading and unrealistic in the context of what these parents are entering into; as soon as babies enter our lives, ‘planning’ becomes a big joke. Kids aren’t a convenient accessory, they’re family members, real people who force us to discover pockets of time and multitasking skills we never knew we had, but also cultivate in us the ability to let go of expectations, and yes, plans, in order to meet the needs—and discover the joys—that the current, chaotic moment presents. Not only do scheduled inductions, as the research concludes, put moms and babies at higher risk, they also sell parents short of the full-blown “Guess what! Nothing will ever be the same as it was…” experience that spontaneous labor delivers. (Pun intended).
I’m glad to see that hospitals are adopting new policies that put health over profits. It’s a step in the right direction, for sure. A few of the articles I read on these policies, however, mentioned a demographic of parents who request scheduled inductions in order for the dads, home on leave from active military duty, to be present during their babies’ births. This is obviously a bit of a different thing than women scheduling inductions because they’re sick of being pregnant, as understandable as that is, or from doctors scheduling C-sections because they’re faster – and they pay more-- than vaginal deliveries do (C-section rates have been rising in the US for several decades, and are currently double the maximum rate advised by the World Health Organization). Military dads wanting to meet their babies before heading back to the war in Afghanistan, well… that’s clearly heart-wrenching (war is not good for families and other living things). But if holding off on inductions is best for babies and moms—and the research certainly indicates that it is—then these policies, in the end, presumably benefit even families with more compelling reasons than convenience for inducing.
Are you surprised by the Australian study’s findings? Did you schedule an induced labor and delivery? Was it medically necessary? Would you do it again, after seeing the recent study’s statistics? Do you think hospitals banning inductions before 39 weeks gestation is a good thing? Should exceptions be made for military families? I look forward to reading your thoughts on this!