Inducing labor for convenience questioned

Hospitals and healthcare organizations across the nation are concerned about induced labor. Several have barred elective labor induction under certain circumstances, such as before 39 weeks of gestation (one week before the due date) or when there isn't clear evidence that the mother's cervix is primed for childbirth.

"People want to schedule their birth like they schedule their nail appointments," says Janie Wilson, director of nursing operations for women and newborns at Intermountain Healthcare, a Salt Lake City-based chain of hospitals that has tried to reduce the rate of labor inductions.

Some experts say induced labor creates unnecessary risks and costs. It can lead to more interventions, such as caesarean sections, and increased use of forceps and vacuum devices to assist in delivery, research has shown. A 2005 study in the journal Obstetrics & Gynecology found that C-sections occurred 12% of the time among women having spontaneous labor compared with 23.4% for women having medically necessary labor induction and 23.8% for women having elective labor induction.

Other studies have found that, compared with spontaneous labor, elective induction leads to longer hospital stays and higher costs. Induced labor also may be more painful because some of the drugs administered to trigger labor can cause more intense contractions.

There is little scientific evidence that labor induction causes any long-lasting harm to mother or baby. But even short-term medical problems are significant given the nation's healthcare economics crisis, Wilson says. According to data, healthy deliveries in the 39th week (and women whose cervixes were fully prepared) incur the lowest costs.

"It could be contributing to the double-digit premium increases you pay each year," she says of elective labor induction's effect on insurance rates. "Cost is the icing on the cake. But it's not the main reason we should be doing this. We should do it because it's safer."

Ascension Health Inc., the largest nonprofit healthcare system in the country with facilities in 20 states, last year requested its doctors follow criteria before proceeding with an elective labor induction. The criteria specified that the fetus must be at least 39 weeks in gestational age, in a specific size range and have established lung maturity, and that the mother isn't already having contractions.

Until more research is done, interventions that are performed without an obvious medical need should be viewed skeptically, says Dr. Michael C. Klein, emeritus professor of family practice and pediatrics at the University of British Columbia.

Doctors who want the convenience to schedule daytime deliveries may be the biggest force for elective labor induction, says Lisa Sherwood, a certified nurse midwife and women's healthcare nurse-practitioner based in San Clemente. Women who "haven't slept well in weeks, have swollen ankles and sore backs" are vulnerable to the suggestion of elective induction. "People look at the doctor as the expert and will do whatever he or she suggests."

But, she says, "once you do an intervention, it begets more interventions, and many women feel they are led down a road they didn't understand. Women tell me, 'I didn't know it was going to end up like this.' Women need to be given all the information on what they are signing up for, not just told, 'You're going to have your baby today.' "

Bonnie - I have never been a proponent of interfering with the natural birthing process unless medically necessary. Childbirth should be a celebrated and welcomed event. It should not be perceived or treated like a medical procedure.