Sunday, August 23, 2009

Why do OBs like induction so much?

Thanks to a CIMS report for spotting the latest American College of Obstetricians and Gynecologists practice bulletin on induction, in which ACOG approves of inducing labor for "psychosocial" (non-medical) reasons and cervical ripening with the synthetic prostaglandin misoprostol (trade name Cytotec). By contrast, Canada and the UK do not approve of these risky methods.

Compared to women who go into labor on their own, women who have an elective induction are at increased risk for intrapartum fever, instrumental birth, cesarean section, and are more likely to use analgesia including epidurals. Babies are at risk for irregular heart rate patterns, shoulder dystocia, neonatal phototherapy to treat jaundice, neonatal resuscitation and admission to a neonatal intensive care unit. According to the white paper "Idealized Design of Perinatal Care" published by the Institute for Healthcare Improvement, "Based on a review of U.S. medical malpractice claims, [the labor-inducing drug] oxytocin is involved in more than 50 percent of the situations leading to birth trauma."

These complications of labor also impact mother-infant attachment and the initiation and continuation of breastfeeding.

ACOG approves of inducing labor at 39 weeks while a similar professional group in Canada states gestational age should be at least 41 completed weeks; UK guidelines state induction for non-medical reason can be considered at or after 40 weeks.

Misoprostol, an inexpensive synthetic prostaglandin, was developed and is marketed to prevent and treat gastric and duodenal ulcers. The use of misoprostol for cervical ripening and induction of labor (off-label use) is approved by ACOG, but not recommended by either Canada or the UK. Misoprostol is not approved by the manufacturer for use in pregnancy. Misoprostol is associated with excessive uterine contractions, fetal heart abnormality, hemorrhage, hysterectomy, and sometimes fetal death. Both Canada and the UK recommend its use be restricted to clinical trials.

Nearly one in four births in the U.S. is induced (many more receive oxytocin to speed things up) and according to the Agency for Healthcare Research and Quality (AHRQ), although it is not entirely clear what proportion of these inductions are elective (i.e. without a medical indication), the overall rate of induction of labor is rising faster than the rate of pregnancy complications that would lead to a medically-indicated induction. According to Childbirth Connection's report, "Evidence-Based Care: What it Is and What It Can Achieve," the most common gestational age at birth among single babies in the U.S. is now 39 weeks rather than 40 weeks.

6 comments:

Justine said...

This is so frightening and so frustrating! Thank you for sharing this important information!

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