Last week, my best friend gave birth to her first baby. She and her husband are thrilled with their new little one, and I’m happy for them as well. But I am unimpressed by the way in which he was born, and by the medical and insurance professionals who handled the birth. The baby was due 12/28. A few weeks before the due date, my friend decided that she wanted to induce labor on 12/27. The reasons were many. Her last day of work was 12/23, and she wanted him born as soon as possible after that, so as to have as much time as she could with him before returning to work. Her husband also had some time off work at the same time, so inducing the birth would also give him more time with the baby. The possibility of a Colorado snow storm that could cause them to have to deliver at a hospital close to home instead of the one they had picked. Tax deduction for 2006. Various family members arriving in town. All these reasons seemed perfectly fine to her when she was describing the planned induction to me. At the time, I did point out to her that inducing labor does carry some substantial risks, and that to do so without a medical reason is questionable. But she was adamant, and on 12/27, she arrived at the hospital before dawn to begin her labor.

From there on, her labor and delivery were textbook examples of why induction should be limited to situations where it is medically necessary. 25 hours after being admitted to the hospital, after administration of prostaglandins, pitocin, an epidural, and various manual methods of induction, she was still hours away from being able to deliver vaginally. And the contractions were so strong that they were causing serious decelerations in the baby’s heart rate. Soon, the baby’s heart rate was dipping to worrying levels, and he arrived via an emergency c-section. The baby was mostly fine at birth, although he was unable to sustain his oxygen levels, and had to spend 4 days in the newborn intensive care unit, with a small amount of extra oxygen being added to the air he was breathing.

Several months before the birth, my friend had begun talking about her birth plan. She wanted as natural a labor as possible, hopefully without an epidural, although she was keeping her options open with regards to the pain medication. She wanted to deliver vaginally. She maintained all of these desires, but also decided that she wanted to schedule the birth. Who knows what her labor would have been like if she had waited to go into labor naturally? Her cervix had to be ripened at the hospital before the induction began, which is linked to a higher risk of c-section. C-sections are in turn linked to a higher rate of complications, including breathing problems. Inducing labor does carry risks, and my friend ended up having several of the problems linked to induced labor (epidural, strong contractions that caused severe fetal heart rate decelerations, electronic fetal scalp monitoring, c-section, and a baby with slight breathing problems). Perhaps she would have had the same outcome if she had gone into labor naturally – there’s no way to know what that outcome would have been. But since we do know that all of these problems do occur with more frequency when labor is artificially induced, why is the rate of elective inductions rising so rapidly?

My friend is happy that she and her baby are fine now, but she has just begun the process of healing from the c-section, and the baby still needs a little oxygen for another few days. Hopefully a few months from now, all of this will be behind them, and both will be thriving. Although we don’t really know if there are long-term consequences to inducing labor. Scheduling labor for convenience is abhorrent. Obviously we know the basics of how labor begins, with the ripening of the cervix and the body’s production of oxytocin to stimulate the uterine contractions. But we don’t really understand all of the minute details, or what actually causes the events to be set in motion. Babies can be born “full term” anywhere from 37 to 42 weeks. This is a range for all babies, not each baby in particular. What if my friend’s baby was “supposed” to be born at 42 weeks? Why are we messing with such a complicated natural process without good cause? In cases of preeclampsia, uterine infection, maternal diabetes, etc. the benefits of induction can easily outweigh the risks. But why would anyone want to increase their risk of complications just for the sake of convenience?

Being a parent is inherently inconvenient. Anyone with children can tell you that. The sleepless nights, the diapers, the expenses, the worrying… no one said it would be easy or convenient. Yes, you can schedule the birth (which may not work out anything like you planned), but you’ll still be taking off on a roller coaster ride of inconvenience that lasts at least the next 18 years (I know of very few parents who truly cut the cord at 18 years, nor would many want to). Why not just let nature take its course, and begin the process of being a parent – which involves giving up some of the control you have over your life – when your baby is ready to be born?

Since it seems that many obstetricians encourage elective induction, I have to also question their motives. Someone who wants an easily scheduled, 9 – 5 job should probably consider something other than medicine, and should definitely avoid obstetrics. End of story. Either you’re willing to deliver babies at whatever hour they happen to come into the world, or you should pick another profession.

Health insurance companies should be taking more of an active roll in discouraging elective inductions. I don’t know exactly what the total cost my friend’s labor will end up being. But nearly 5 days in hospital, 4 days in NICU for the baby, the drugs for the induction, epidural, the c-section, and all of the monitoring that went on – it can’t be cheap. And yet my friend will end up paying no more than if she had gone into labor on her own and been able to deliver vaginally. Health insurance companies need to stop paying for induction of labor that is not medically indicated. Perhaps if mothers-to-be had a financial incentive to wait for labor to begin on its own, not as many of them would choose to put themselves and their babies at greater risk, just for convenience.

So there it is. Parents, doctors, and health insurance companies all have a part in this. Although it takes no training to be a parent, so I hold the doctors and health insurance companies more accountable. Tell the patient no. Do not induce labor just so that a mother can schedule the birth around the rest of her life. Do not continue to pay for induced labors (and all of the other costs that can arise once the induction has begun) that have no grounding in medical science. Induction and c-sections are powerful medical tools – not toys.