The Costs of Elective Induction of Labor

A friend of mine recently gave birth, and opted for an elective induction the day before her due date.  The induction was done for scheduling purposes rather than any medical reason.  She was aware that inducing labor does carry some substantial risks, but had several reasons for wanting the baby born at a particular time and hoped that the induction would go smoothly.

It turns out that her labor and delivery were textbook examples of why induction should probably 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?

Since it seems that many obstetricians agree to 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 couldd 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.

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Comments

  1. Elizabeth Songer says:

    Thank you for writing this. I used to work with a girl who was induced so her baby would not be born on the 4th of July. (Why she cared, I don’t know.) She ended up getting a c-section and then developed a post-partum wound infection and packed her incision for weeks! I work as a nurse in a post-partum unit and I think elective inductions are ridiculous. I have even seen scheduled c-sections done “per mother’s request.” This is a sad, sad world.

  2. I agree and disagree with you. Sure, some mothers are selfish and want the elective inductions to fit their schedules or because they want to be done before 40 weeks. And some mothers don’t want things “ruined” in the southern region so they elect a c-section. I do not agree with these. HOWEVER, other mothers make the decision due to other reasons – such as you are on your third pregnancy, past your due date, and have had large babies usually around 38 weeks vaginally/naturally and by some form of luck, was lucky your baby didn’t come out with a broken collar bone. Babies continue to grow after 40 weeks. And further, as you go further into being past your due date, the placenta stops working at 100% and the amniotic fluid starts to decrease, which then causes the baby to receive less oxygen. Oh and let’s not forget the baby could inhale it’s own feces. Studies show that going past 41 weeks poses a greater threat to the baby, even if the baby is showing happiness and content in the womb at 41 weeks.

    So thanks for judging all mothers who elect to induce. You obviously haven’t had to face this before so are completely unaware of maternal fears that could arise. I’m currently having to face the decision of induction after having two children on my own completely natural. Do you think I want to be induced? I would love for my body to do this on it’s own but I’m scared to death something is going to be wrong if I don’t agree to an induction.

  3. Julie,
    I wish you all the best with your decision and with your baby’s arrival. It’s been four years since I wrote this post, and in re-reading it, I can see how the tone is a bit more judgmental and harsh than I would currently be – I apologize for that. Our second child is due in a couple weeks, and I’m no stranger to the myriad of worries that a mother faces during pregnancy. I do believe there’s a huge difference between an induction at 41 weeks based on a medical concern (such as decreasing amniotic fluid levels) and an induction strictly for scheduling or convenience purposes. The point of my article was to express my opinion about purely elective inductions, when there is no medical cause for induction. These are sometimes requested in advance, and doctors do sometimes agree to them. Once genuine medical concerns arise, it becomes a valid issue between the doctor and the parents, and is no longer what I would call a truly “elective induction”. Again, best of luck to you, and I hope that all goes well with your baby’s birth.

  4. I think you should be ashamed of yourself for your judgemental attitude toward induction. What about the mental and physical health of the mother???? And do you know what it takes to claim medical necessity for these insurance companies? I’ve been sick for the last 6 months of my pregnancy with certification from my doctor that I could not work. My STD claim was denied, so I’ve endured the most miserable and debilitating 6 months of my life because I’m working with constant migraines, nausea, vomiting, SPD and general anxiety as the aftermath of all of these things and also going through a reorg at work.

    However, my blood pressure is perfect, and the ultrasounds and other tests show good results.

    I am perfectly capable and trustworthy enough to determine how and when I deliver if I want to. For those of you who want to go natural, fine. But stop regulating my body and let me work with my doctor to determine what’s best for me and my baby!

    Let the doctors do their jobs and let the mothers rule their own bodies and mind your own business.

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