Monday, April 27, 2009

Inductions at record levels

A report released today from thh Childbirth Connection shows a shocking induction rate in the US of 40 percent!

Widespread Use of Induction Potentially Harmful to Woman and Baby

NEW YORK, NY – Induction of labor is on the rise in the U.S., standing at 41% according to a large national survey of women who gave birth in 2005. But, a new study published in the April issue of BJOG, the peer-reviewed journal of the Royal College of Obstetricians and Gynaecologists, finds that the best available evidence does not support many reasons medical providers give for using drugs or other measures to cause labor to begin.

The investigators found support only for inducing labor at or beyond 41 completed weeks of gestation and under some conditions when a woman's membranes break before labor. However, there is not good evidence for inducing labor in many other situations, including when the fetus is believed to be large or to have restricted growth, or when a woman is pregnant with twins, has insulin-dependent diabetes, or has low levels of amniotic fluid.

The study’s lead author, Dr. Ellen Mozurkewich, a maternal-fetal medicine specialist at the University of Michigan, said, “The best available evidence does not support routine inductions in many situations for which induction is currently being recommended to patients. More research is necessary to clarify the risks and benefits of induction in these situations."

Many pregnant women may be receiving inappropriate care. For example, 17% of women who participated in Childbirth Connection's national Listening to Mothers II survey in 2005 said they had been induced because their caregiver was concerned that their baby was too big. However, best evidence suggests that labor induction is not beneficial in this case.

“We now know that every week of gestation counts in terms of brain and lung development. When there is no good reason to end pregnancy, mothers and babies benefit from waiting for labor to begin on its own,” said Carol Sakala, Director of Programs, Childbirth Connection. “Starting labor early can lead to negative outcomes for the woman and/or baby."

To foster high quality maternity care, Childbirth Connection, a research and advocacy organization, commissioned this study through a grant from the Transforming Birth Fund of the New Hampshire Charitable Foundation.

Concerns about inducing labor without an established medical rationale include increased risk of cesarean section for some mothers (e.g., first-time mothers and women with a cervix that is firm and closed), and babies who are born before full lung and brain maturation. Estimates of how long a fetus has been developing can be off by up to two weeks, and labor induction can unwittingly end with a preterm birth.


pinky said...

I really wish they would cut that out! What a huge pain for everyone involved.

Amber said...

It happened to me...induction leading to c-section. I re-think my decision of consent on that all the time, and it was 7 years and 4 c-sections ago.

40% is a very sad statistic on this.

NursingBirth said...

This article still leaves me frustrated and upset, even though it's no big surprise to in my hospital have absurdly high induction rates. And it's one thing for a doc to convince a mom to be induced for some elective reason (ie "I'm going out to town), she might be dupped into not being told the risks of inductions but no one is claiming that its for a medical reason. But its another to convince a mom to be induced for "medical" reasons that are not suported by the literature (ie suspected macrosomia...a personal favorite of mine (um...not!). Those bother me the MOST. Bottom line: inductions take MORE time, MORE staff, MORE money, and have MORE risk than a spontaneous vaginal delivery. Its all so frustrating!!!!

Thanks for the story!


anjie said...

40%? That number seems low to me. I thought it would be higher. If 33% of moms in the US have c-sections and 40% are being induced, then would that mean 27% go into labor on their own? That isn't the case where I am. When I go to my neighborhood playgroup and say anything true(or they might say negative) about being induced, it is a sure conversation killer. There are many misconceptions about it and women beg their doctors for it. They don't want to know it might harm their baby or them.

CNH said...

I agree that the number seems very low. I wonder if a woman comes in for her induction and contractions are seen on the monitor if they then report it as "augmentation"? Because where I live and work, EVERYONE gets pit at some point in their labor unless they expressly refuse. And when a client recently did, they punished her afterward by mashing her fundus to "clear out the clots". She was at "higher risk of hemorrhage" because she didn't accept the pit. Erm, isn't that the other way around? You get pit when you hemorrhage. Not you hemorrhage because you didn't get pit.

Jennifer said...

This makes me feel anxious...I am over 30 weeks pregnant with my third and totally expecting to be induced - I have a history of very high blood pressure right at the end of my pregnancies - so much so that my first son died/was stillborn just three days before his due date. Is this considered a medically-necessary reason to induce labor or is it just one more unjustified claim?? What's a greater risk - the induction or the HBP?

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