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Opinion: By TODAYshow.com contributor and "Ask Kitty" columnist, Kitty Schindler -- Have we forsaken Mother Nature again?
A recent report in the American Journal of Obstetrics & Gynecology points to a trend that troubles me as much as the skyrocketing rate of c-sections I’ve written about in the past: The number of American moms who have had labor induced nearly doubled between 1992 and 2003.
As a nurse I worry about this –- as do researchers at the Centers for Disease Control and Prevention -- because I know that even though babies born in the 37th or 38th week of pregnancy are technically considered full-term, they are likelier to have problems than ones born after a full pregnancy (typically about 40 weeks).
What kinds of problems? According to Dr. Michael S. Kramer, a senior researcher at McGill University in Montreal, late preterm babies (i.e., those born around the 37th or 38th weeks) are “more likely than full-term babies to suffer complications at birth such as respiratory distress; to require intensive and prolonged hospitalization; to incur higher medical costs; to die within the first year of life; and to suffer brain injury that can result in long-term neurodevelopmental problems.” In addition, he points out, “rates of death and respiratory distress are higher, and babies born earlier average somewhat lower IQ scores.”
Kramer calls the rising levels of late preterm births “an important public health issue,” and I agree. As a mother of two as well as a nurse, I feel strongly that Mother Nature’s “wait and watch” is the best practice. And though Kramer acknowledges that induced labor may be becoming more common due to new technologies like Doppler ultrasound that enable doctors to monitor pregnancy more closely, he also says it’s possible that some labor inductions may be happening for the sake of “convenience.”
And that’s what disturbs me most about this trend: There are many valid reasons for inducing labor which mother and doctor can decide together, but CONVENIENCE is not one of them.
To bring a healthy baby into the world is such a joy; why take chances? Those last weeks, uncomfortable though they may be, allow further time for development of vital organs. What could possibly take priority over time to allow baby's heart, lungs and brain to fully mature?
I say: Give your baby the best chance for a great start in life. Don't short-change him or her in the final weeks of pregnancy after putting in so much time already.
Related stories:
Discuss: Would you induce labor in the final weeks of pregnancy?
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LOL easy to say when you're not 9 months pregnant ;) I'd take and induction after my due date, but I'm in more of a hurry than most because my 42nd week leaves room for my son and daughter to have the same birthday.
Jeesh, what a stupid thing to say. This is why there are so many inductions. Too many women are so uneducated about the risks, or are willing to be induced for the most inane reasons.
I had my children in the 70's. Yes, I know to all of you young mothers, it was a long time ago. the doctors had just started inducing patients and it was mainly for convenience. They would have a certain day during the week and everyone would come in and get induced on that day. At least that is what we were told was going on. I was late with each of my children. And they were all healthy - there is no reason to induce for convenience. You are putting your baby at risk. Either God is in control of your pregnancy or the doctor is. You have to decide.
Bravo! Bravo! Bravo! Bravo!
Once I did my homework and discovered what pitocin would do to my baby, I realized that it was worth the MAJOR discomfort of those last weeks of pregnancy.
Here's another article from the National Institutes of Health I recommend to people: http://bit.ly/8nrxxb
"Pitocin is the most abused drug in the world today." (Roberto Caldreyo-Barcia, MD, former president of the International Federation of Obstetricians and Gynecologists)
I've been induced with two of my children.
On the first labor: I give my doctor kudos because A) he wouldn't induce me at 40 weeks. And B) I had to wait until 41 weeks, no matter how much pleading and crying I did. But my body wasn't ready at 40 weeks.
On the second labor induction - it was out of convenience. My husband was out of town around the due date and that doctor would not consider inducing until you are 39 weeks pregnant. Period.
At this point, I would never ask a doctor/midwife to induce before 39 weeks. It's so dangerous to the baby. I'm still in shock that my friends have c-sections when their babies are 37 weeks along.
I'm scheduled for another induction one day before 40 weeks because my husband will be in training and is able to fly in for that weekend.
I cast no judgments on women who chose inductions. I just hope they educate themselves and realize that two to three more weeks of being uncomfortable isn't going to kill them.
I think it comes down to one thing: control. Women want control over their lives. When you have a baby, women (most women anyway) have to relinquish control to mother nature and the babies they are choosing to bear. I know I don't like it, but then, who wants to have a sick baby and be recovering from major abdominal surgery just because you wouldn't wait 2 more weeks?
There's also the convenience of the doctor, which is arguably an even worse reason to induce than the convenience of the mother.
Inductions should be reserved for true medical reasons, and not for convenience or supposed 'big' babies. By letting nature take its course, mother and baby work together to create an optimal birth situation. When tampering with nature, women should be aware that birth is more risky, and involves a whole package deal of other interventions that have consequences and drawbacks for mom and baby.
supposed "big" babies is not fiction - my first child was 10 lbs. and 2 ft. long - he was too big for me to deliver naturally yet my Dr. wanted me to try - they induced me @ 43 weeks and I almost bled to death during the delivery. I believe that each instance should be evaluated between the mother and the doctor.
And we wonder why we have the highest mother and infant mortality rate in the developed world? We're always on the lookout for shortcuts. We take risk after risk because it's convenient or because we're afraid of a vaginal delivery (and major abdominal surgery is easier? Spare me!) or because someone convinced us that modern births need x or y. Bollocks. I had a high-risk hospital delivery with my first, a low-risk birth center birth with my second, and a low-risk home birth with my youngest. The first one couldn't be helped- it truly was necessary to have all of the machines. But the other two? Let it happen when your body says you're ready. It is sooooo much better, all the way around.
While I went into labor naturally at 38 weeks, my labor stopped and ended up being put on pitocin and eventually had a c-section because the cord was wrapped around my son's neck. Of course at 35+ weeks pregnant the thought numerous times about asking my doctor to induce me, but I never actually did. Due dates are just an estimate... many due dates may be incorrect, which is probably why so many women carry for 41 or 42 weeks. So, if someone is induced at 37 or 38 weeks, they may actually be bringing their baby into the world as many as 4 or 5 weeks early. As uncomfortable as you may be, nothing is better than having a healthy baby.
I'm not a fan of induction. Even with ultrasound and more accurate dating, it can be off, proving dangerous to the baby. The first I was scheduled for induction at 42 weeks, but at 41w6d, labor happened. Still needed pitocin because labor wasn't progressing and ended up with an emergency c-section due to the cord around her neck. This time I'm in Germany and they won't let you go past 41 weeks. We are hoping to not have to induce, but we'll see.
It's always been a gamble of inconvenience as to when the baby will be born - that's just part of life. There is a pretty good chance that DH will be in Poland when the baby is born since he's scheduled to return 4 days before the due date. Of course, he'll be gone almost a whole month, so early induction isn't an option, but I wouldn't ask for it even if it was at 38 or 39 weeks when he was leaving instead of 36. You just never know when the baby will be 'ready'.
42 years ago with my first I got pitocin after32 hours as my contractions had ceased to be strong enough. Baby delivered in a hurry after they couldn't find his heartbeat. His cord was wrapped around his nck twice, with a knot which pulled tight at the end of labor. This was before fetal monitoring was possible--he is fine now, but it was scary and should have been a c-section. Baby 2 came with 2 pushes--what a difference!
I had my first child t 38 weeks, 1 day without induction. I actually refused pitocin when the doctor recommended it. When I first went into labor I told him I didn't want pitocin. Later the nurse told me he recommended pitocin and I asked "why". She said that my contractions weren't progressing quickly enough (!) I told her I'd like to wait an hour and see if my labor wouldn't take off. It wasn't long before everythign got moving, and I gave birth about three hours later.
With my second child I was induced at 38 weeks. I had gestational diabetes and my blood pressure had started to creep up. But it was ALSO the week before Christmas and I was due on New Year's Day. So. Was I induced for "convenience" because my doctor didn't want to mess with her hioliday, or because I was having health problems? I don't think I'll ever know. I CAN say that the pitocin-induced delivery was MUCH harder. I didn't have an epidural with my first, but I couldn't stand the pain with my second. I think I might have gone into sponataneous labor within the next day or two anyway, but I have no way of knowing for sure.
Thankfully both boys were healthy from the start. No breathing problems or anything. They were both 8 pounds at birth.
I went into labor naturally at exactly 38 weeks! I was later put on pitocin to speed up my labor which ended up vaginal! Thank God! I think because of insurance they choose to use pitocin to simply speed up labor in my case. Later when I asked is 2 1/2 days a long hospital say for new mothers. She said it was just fine. Which lead me to think they want that baby out of you and out the door. Probably not the best philosophy to have...but i'm just happy that I have a healthy son with no complications. My mother later told me that when I was born 1984 the hospital stay was 1 week! MAJOR DIFFERENCE!
Funny, my son was born (induced because my water broke and labor didn't start within 48 hours) in 1988 and I was out of the hospital in 2 days!
There was a big stink about "drive through births" a couple of years ago...did anything ever come of that?
I don't understand why anyone would CHOOSE to have labor induced. It wasn't any fun.
When my first was born in 1987, there was a 24 hour program--also called "drive thru" birthing, where the 24 hours started from when you entered the hospital. If the baby was born okay, the placenta came out fine, and your color was good, then you got the special price and sent home. Fortunately, government or common sense stepped in and added more post-delivery time.
WARNING! BIRTHING WAR STORY FOLLOWS!
My first was a 24 hour special (no induction), and my second preg. was twins. I was induced as the water had broken and contractions had gone irregular and dialation had not continued. First baby was vaginal, the second was emergency C-section due to distess (heartbeat dropped and baby shot away from birth canal). I was in for three days and sent home. The babies had some complications and stayed more than a week. They're at college now, A students and doing fine.
Due to a medical condition, I had to be induced at 39 weeks with my now-9-month-old. I was was very relieved when the medication used in the initial stages of induction brought on full labor and I didn't need pitocin. It sounds so hypocritical, given that all of my pregnancies will be considered high-risk and I'll need to be induced for all, but I would encourage mothers to allow things to happen naturally. To go from no contractions to suddenly having them 2 minutes apart is extremely stressful!
You know, it's really easy to vilify elective inductions for convenience, but let's consider the situations that put us there. In the US there is no mandatory paid maternity leave. Those companies that do offer leave (paid or unpaid) only offer it for a few short weeks. Do you want a woman spending her maternity leave sitting around the house waiting to have a baby (I don't think anyone can reasonably expect a woman to work at 40 weeks!), or taking care of a newborn? What about the previous commenter, whose husband's work/travel schedule dictated a scheduled induction? What about all sorts of very real issues (like childcare, help around the house, etc.) that lead to elective inductions?
It's easy to point fingers and make monsters of the doctors and mothers that choose inductions for these reasons. But I've never known a doctor (and I know quite a few) who would induce because the mom was simply "tired of being pregnant." I don't want to read another article trashing mothers (and doctors) for choosing to induce for elective reasons until we as a society come together and eliminate the need for working mothers to schedule their births. You shouldn't have to choose between your job and what's best for your baby.
You're right--support for working parents (both mothers AND fathers) in this country is appalling. It's an embarrassment and it's shameful, quite frankly.
I totally get that. I do. But I still don't see that as a reason to take unnecessary risk with my body or with my baby's. There's a reason why the infant mortality rate in America is second-to-last in the developed world (more infant deaths per 1000 than countries like Cuba and Slovenia, and at the SAME LEVEL as countries like Croatia, Serbia, and Belarus). (http://bit.ly/1wlmRH)
We have better doctors, better facilities, better medical schools and better infrastructure than ALL of those countries. So what's the difference? Medical interventions in birth. The medicalization of birth.
I'd really like to go out on a limb and say that the use of pitocin for elective inductions (for scheduling reasons, work reasons, etc) is probably just a micro-sliver of the problem. The biggest problem, in my opinion, is the epidemic of defensive medicine that's practiced in this country. Far too many doctors are making medical decisions based upon the threat of being sued. THAT, I think, is the problem.
I think they need to check their statistics. The numbers they cite in their study don't differentiate between elective induction and induction based on the baby or mother being in trouble. I'd be curious to see what the risks were for each group. I suspect the issues that they talk about relate more to the cords being wrapped around their necks rather than being born a week or two early.
I've had 5 healthy babies, all 5 delivered vaginally, the last two were induced at 38 weeks and 39 weeks, respectively, out of 'convenience' for me - we have no family/friends nearby and no one to watch the others had I gone into labor in the middle of the night. All of my children were just fine. I'd even argue that the last two were the healthiest/easiest, but that may be because I'm an older an wiser mom. =)
Studies/statistics are important, but people need to be sure they understand the results and don't apply them in a vacuum. Nothing in life is that simple.
@Char-1943220- All of those "very real issues" sound like reasons to delay starting a family to me. If you are not at a state in life where you can make time to deal with having and taking care of a baby, maybe you should wait. If you can't afford to take time off of work during the last few weeks/months of your pregnancy and still be able to spend the first several weeks/months with your baby before going back to work I would say that you're not ready to have a baby. If someone is stretching themselves so thin that they need to schedule their child's birth into their work plans, that person is just not financially ready for a baby. Save some more money so that you can afford to take the necessary time off when you have your baby without having to worry about fitting that time into a very small window. That is unhealthy for the baby and the added health costs raise the health insurance costs for the rest of society.
@Char-1943220- All of those "very real issues" sound like reasons to delay starting a family to me. If you are not at a state in life where you can make time to deal with having and taking care of a baby, maybe you should wait. If you can't afford to take time off of work during the last few weeks/months of your pregnancy and still be able to spend the first several weeks/months with your baby before going back to work I would say that you're not ready to have a baby. If someone is stretching themselves so thin that they need to schedule their child's birth into their work plans, that person is just not financially ready for a baby. Save some more money so that you can afford to take the necessary time off when you have your baby without having to worry about fitting that time into a very small window. That is unhealthy for the baby and the added health costs raise the health insurance costs for the rest of society.
There's a lot more to infant mortality statistics than Jen suggests. Sure, we have the best doctors, facilities, etc in this country -- if you have access to them. We also have probably the largest population of uninsured mothers in the developed world, leading to lack of appropriate prenatal care for large numbers of women and babies. And it is usually the people in the middle who suffer most -- the poorest can get government aid even now (if they can navagate the red tape) and the wealthier folks can afford insurance. It is those who are getting by in the lower middle class, paying their bills without assistance and working to live often paycheck-to-paycheck without insurance offered through work who have very little assistance. I know some people will start arguing politics over this but no matter whether you are a D or an R it doesn't change the fact that this is a serious issue in our country.
Medicaid is ridiculously easy to get for pregnancy. My patients drop their private insurance and get medicaid for pregnancy. Almost universally the patients that I have delivered without prenatal care, never made the effort to get medicaid or prenatal care. When they deliver, they get approved for emergency medicaid to cover their deliveries.
Elective inductions are only approved after 39 weeks gestation by ACOG (the governing society in US for obstetricians) if they have good dating. This time is chosen because due dates can be off by as much as 2 weeks. Inductions prior to 39 weeks should only be done if medically indicated (large baby doesn't count) or if an amnio is done to confirn lung maturity. Babies are usually not allowed to go beyond 41 weeks because risks increase, most specifically fetal demise in utero. A dead baby, especially at term, is one of the worse things a family can go through.
No! I can't imagine anybody working while 40 weeks pregnant! Who are you kidding?! I worked all the way up until I was induced at 39 weeks and 6 days with my first one. I was too nieve to stand up to my Dr and tell him no to induction. That was the most painful experience of my life. I learned though.
With #2 and #3 I delivered at home to control my own labor. Much different. And guess what... I took care of my kids all the way up until I delivered. As a matter of fact, my children were only gone for about an hour during both and then I was back on duty as mommy. I think so many highly underestimate women (including other women). Our bodies are very capable of handling labor... seeing as how that's what it was designed to do. (I have a friend who delivered and almost 11lb baby at home with no tearing.)
Give your bodies a chance to work. I completely understand if it absolutely needed, but for those that aren't, I just don't get. And I was one of them!
There is far too much medical intervention in the birth process today. It's a terrible trend. I absolutely would not induce unless it was medically necessary and only then after I had tried natural methods first.
I'm currently pregnant with my third and last child and we having a homebirth with a midwife. I simply cannot put myself through the stress and aggravation of a hospital birth where they are constantly trying to hurry things along. I'm so glad my baby will be born peacefully at home.
My daughter was induced at 43 weeks and still ended up a C-section after her heart rate skyrocketed and my blood pressure plummeted. She is 20 years old now - out on her own and doing fine. I can't believe someone would induce for convienence! But that was not an issue for me so I won't judge.
Hospitals in Ohio are making directed efforts to reduce births before 39 weeks and are seeing great success. More about the Ohio Perinatal Quality Collaborative is available via Cincinnati Children's blog at: http://cincinnatichildrensblog.org/ohio-perinatal-quality-collaborative-improves-infant-health-controls-costs/
I have two children born nine years apart. With my son, I was induced several days after my "doctor determined" due date, though closer to two weeks after MY guesstimate at my actual due date. Thank Goodness my doctor trusted me and agreed to move forward. After a twelve and a half hour labor, I delivered a perfectly healthy 6lbs. 13 oz. baby boy. Conditions in the placenta though were definitely beginning to break down and being that I was 3cm dilated and 90% effaced, the fact that labor had not been triggered in my body perplexed us all. While I'm thankful for the induction coming in time, it was not the most pleasant experience. My water was broken, pitocin was started, and contractions came hard and fast from the start. Fast forward nine years and I was induced again with my daughter. This time at 37 weeks and because of toxemia. Again, another beautiful, healthy baby...thank God. And my daughter, gestationally five weeks earlier than my son, weighed 7lbs. 4 oz. Go figure! With this induction though, they began it the night before with a gel on my cervix. Then they started the pitocin off low and slow at 5am. I didn't even start to feel slightly uncomfortable from the contractions until after 8am (and was making progress!). My water wasn't broken until seven hours in to the labor and at that point, things became more intense. It took over fifteen hours to labor with my daughter, but the more "natural" feel to the labor was worth it!
In each case, for very different reasons, I had an induced labor. Was it my preference? If I'd had a choice, no. But I'm certainly glad it was an option!
Here in Germany they don't have the 'rush you out the door in 24 hours or less' attitude you find in many US hospitals. I want to say it is 5 days for vaginal and 10 for a c-section, but you can leave earlier if you like. For US forces, we have to stay at least 72 hours for that first check up, but if all goes well, I plan on coming home after that. I think it's great to have the option to stay in the hospital that long for a first time mom, I had 5 days after my c-section in the US because DD was on antibiotics, but they would have sent me home at 4. I think vaginal they kept you overnight, but I don't know if it was any longer. If you have other kids at home, I can see wanting to get home sooner rather than later.
Another problem in the US (other than the maternity leave situation) is that many of us have moved away from our families or our mothers are working and can't be around to help out with the new one. There isn't as much family/community support for new mothers as their once was because everyone's working. I'm fortunate to be able to stay at home, so that's not an issue and my mom is flying out to Germany for the end of the pregnancy to help out - so that will be nice. And we do have the support of the military community if I do go into labor while DH is gone.
My doctor wanted to induce me right on my due date, my husband and I disagreed and we waited another 7 days - at this point the doctor was urging us to decide whether we wanted induction or c-section, I feel that the doctors do this for their convience, and it should be for medical reasons and not just because the doctor say it's time. The baby should come sooner or later. My husband and I were very upset at our doctor because he didn't want to give us more time - he was saying that he wasn't going to be responsible if something happened to the baby and that the baby should be delivered soon before it gained more weight, but the doctors try to scare you, I am so glad my husband and I choose not to be induced, our baby was born by c-section. Please be careful when doctors suggest induction. Read ahead and don't let the doctor decide.
With a due date of August 10th I was finally induced on August 29th. My son, who weighed 9 lbs 10 ounces did not get all the fluid squeezed from his lungs and was in the special care nursery. At this time - 20 years ago - all the beds in the special care nursery were incubators. It took two nurses to get him in the incubator because there was bed it was only 1 inch longer that he was! The neonatologist said he gestational age was 42 1/2 weeks. I had no signs of going into labor (no dialation or thining of the cervix) on my own. Gee, maybe if I waited to go into natural labor I could have had a 10 or 11 pound baby that would have been to long for the incubator!!!
19 days was way too long to wait. Your doctor was incompetent.
They should have induced so he'd fit an incubator he didn't need? My 1st child was 10 lb 5 oz & 2 ft long at 41 weeks, and it was fine. There is no "right" size. If your son had needed more space to stretch rather curl up in the incubator, I'm sure a bed could have been brought in. Induction to avoid needing more room seems extreme.
My doctor wanted to induce me 2 days after my due date. It was a Thursday. I know it was because they didn't want to do it on the weekend. Thankfully I went into labor the day before the scheduled induction. If it hadn't happened I would not have gone through with induction. Unless there is a medical reason, I don't feel it is necessary. Of the many family members and friends who have been induced, not one had a good experience with it. Labor is a natural part of life, why mess with it?
My doctor wanted to induce me 2 days after my due date. It was a Thursday. I know it was because they didn't want to do it on the weekend. Thankfully I went into labor the day before the scheduled induction. If it hadn't happened I would not have gone through with induction. Unless there is a medical reason, I don't feel it is necessary. Of the many family members and friends who have been induced, not one had a good experience with it. Labor is a natural part of life, why mess with it?
I was induced for two of our five children, BUT they were well past their due date, AND I still
delivered them vaginally, without any drugs whatsover. They weighed
7lbs15 oz and 9 lbs. I would not have done it otherwise. I definitely would not have done it
for convenience.
My doctor wanted to induce me 2 days after my due date. It was a Thursday. I know it was because they didn't want to do it on the weekend. Thankfully I went into labor the day before the scheduled induction. If it hadn't happened I would not have gone through with induction. Unless there is a medical reason, I don't feel it is necessary. Of the many family members and friends who have been induced, not one had a good experience with it. Labor is a natural part of life, why mess with it?
I think a lot of docs push the idea of inducing so they don't have to deliver a baby on the weekends or in the middle of the night. That's just plain wrong. Under normal conditions, baby will come when baby is ready.