Tuesday, August 7, 2012

Question your Induction

I want to be clear, I believe that women should make decisions for themselves with regards to birth, and I am not writing this to criticize anyone's decisions. I am writing this because I feel that the true risks of medical induction of labor are not accurately explained to women. Nothing irritates me more than the withholding of information. My goal is to inform, not to criticize, scare, or coerce.
A medical labor induction is a procedure in which labor is started by artificial means. The most common means of labor induction is the use of Pitocin, a synthetic form of oxytocin. There are many reasons that inductions are performed, many of which are legitimate (such as preeclampsia, deterioration of the placenta, and premature rupture of membranes without onset of labor). However, elective inductions are on the rise. An elective induction is a medical induction that is performed for reasons other than a medical need. This practice is not recommended by ACOG (the American College of Obstetricians and Gynecologists) or the WHO, yet many OB/GYN's suggest and even pressure patients into elective inductions for reasons of convenience. I find it absolutely appalling that they do this without informing their patients of the true risks involved.

Risks of induction include abnormal fetal heart rate, shoulder dystocia, fetal distress, increased risk of NICU admission, increased risk of vacuum- or forceps-assisted delivery, increased risk of C-section, increased risk of baby prematurity and jaundice. Not to mention the risks associated with a Cesarean section. Often reasons for induction outweigh the risks, but are these risks justified for the sake of convenience?

Here are some statistics involving Medical Inductions and Cesarean Sections in the United States:
  • In 2009, the C-section rate in the U.S. was 32.9%. That is 1/3 of all births! The WHO has stated that a C-section rate higher than 15% is a cause for concern.
  • In 2008, the induction rate in the U.S. was 23%. Of those inductions, 40% were elective (for reasons other than medical need).
  • A labor that is medically induced is twice as likely to end in C-section than a spontaneous labor.
  • A recent study published in the journal Obstetrics and Gynecology found that more than 43% of women expecting a first baby were induced. Of these nearly 40% were being induced for convenience. More than 1/3 of women undergoing induction for convenience had a cervix that was known to be unfavorable for induction. Using a very conservative analysis, the authors estimate that fully 20% of all C-sections done at their institution were the result of inductions for convenience (Ehrenthal et. al., 2010).
  • Another study found that first-time mothers with an unripe cervix who were induced had a 42% C-section rate in labor (Thorsell, et.al., 2011).

The end of a pregnancy is not much fun. Elective induction can begin to sound very appealing. But before you schedule an elective induction, take a look at the risks and really ask yourself if it's worth it to you. Medical induction is one of the many incredible medical advancements we have available to us, but these interventions should only be performed if the benefits outweigh the risks.


1 comment: