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.
The Costs of Elective Induction of Labor
January 2, 2007 By