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Monday, January 9, 2012

Induction Epidemic

As I mention in my book, we still don't know exactly how long a human baby needs to gestate. We don't usually know the exact date of conception, and we have no real understanding of why or how labor starts. Statistics are wonderful tools for proving a point, so I am going to shy away from using them for now. I have read endless discussions on medical professionals' lists about the benefits and risks of 41 week inductions, and I am not at all convinced.

My father is very ill. His body is getting weaker and weaker, and when I was caring for him over New Year's he seemed as frail as a preemie, and weighed about as much. But his mental state is still as sharp as it ever was, his sense of humor as dry, and he had a wonderful New Year's toast with all of us, wishing us all a Happy New Year.

I don't know when he is going to go. It could be in two weeks, it could be in two years. But none of us would think to hasten his departure by giving him some meds that would call on the Angel of Death. Of course, if he were already half gone, we have been ordered by him to let him go. But as it is, we are waiting, trying to stay in touch as much as we can. My mother is there, cooking his favorite food and listening to his favorite music with him, reading him detective stories and generally fussing over him.

As it is at the end of life, so should it be at the beginning. If a woman and her baby are doing well, and all the medical tests show that everything is fine, then there is absolutely no reason that the baby and his mother should be "stimulated" to start labor. I am not arguing that once a woman reaches forty weeks she should be abandoned by her medical caregiver. Certainly, she can have a weekly Non-Stress Test or a Biophysical Profile. But if these tests show that all is well, why are we relying on numbers and averages to make medical decisions?

We had a holiday season recently. The hospitals in our city were packed during the week before Christmas. It wasn't because everyone had been having wild sex at the end of March last year. It was because women, their partners, and their medical caregivers wanted those babies to be born before the holiday, so they decided upon induction rather than waiting and suffering the inconveniences that would result.

A doula is a very useful resource in this situation. She can and should help the parents-to-be understand the advantages and disadvantages of induction, and help them to ask the medical caregivers the right questions. Informed choice is not just a buzzword, it actually means that the patient is informed and can make a choice. The patient should be informed, not just by the doctor who has to go away for Christmas, but also by someone who can inform her that if her cervix is long, closed, and high, and she is a first time mother, and her mother and sisters all carried their babies to 42 weeks, then  she may have a higher risk of ending up in surgery than if she waits a few days and trusts her doctor's backup.

There is an induction epidemic going on. Induction can and does lead to further interventions. If a prostaglandin induction does not stimulate labor, then oxytocin is initiated. Prostaglandin gel, IV oxytocin, and epidural medication can have a bad effect on the fetus, and may lead to emergency cesarean birth. All of these interventions are miracle workers when they are used to save a mother's or a  baby's life. To use them for social reasons is not only bad medicine, it is a sad reflection on our culture and our way of life.

1 comment:

  1. first of all I'm sorry to hear about your father and I'm sure he is in good hands with you and your family. may we only hear good news. thank you for writing this post. that helps me understand also why they bug you to induce when you're not even due yet! my dr. was away the last while before I gave birth so I saw other residents and one of them; it seemed like he expected me to agree and it wasn't even the due date yet. like this is a normal thing to do. sad to think how unsuspecting people might fall for this. so important to know to stand up for your rights.

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