Those Crazy Induction-Loving Moms
Wednesday, February 3, 2010 at 4:49PMBy Emjaybee
A hospital in my area (north Texas) has decided to limit inductions, which is great news.
What’s not so great is the implication in the news article that the high induction rate was the fault of mothers, and not in any way part of hospital policy or encouraged by doctors.
Experts know that mothers should wait as long as possible, but in recent years, induced deliveries have become more common — sometimes just because the mothers ask for it. “Women are tired, or maybe it’s a convenience thing; maybe they want their physician to deliver them, and they know their physician’s going to be going on vacation,” said Debbie Cates, director of Women’s Services at North Hills Hospital.
Now, I don’t know if an official study has been done regarding non-medical reasons for induction, though thanks to Mom’s Tinfoil Hat, I can link to this detailed discussion of some of the many complex “psychosocial” factors that do lead to inductions.
However, I do personally know many, many women who were told by their doctors that they were going to be induced early—as early as 36 weeks. Not asked, told, for reasons that included “getting the baby here before the holidays/weekend/I go on vacation” to “not letting that baby get too big” to “if you go into labor on the weekend, we don’t have as much staff here, so let’s induce on Friday morning.”*
Yet there is hardly the hint of a whisper in this article that this extremely widespread practice of doctor-pushed inductions ever occurred in the hallowed halls of North Hills Hospital. Maybe it didn’t. But I wouldn’t bet money on it.
* This was my provider’s reason, by the way, though I held out till Monday, when my water broke, and then I was put on Pitocin simply because I was at 42 weeks, even though I was laboring quite well. And thus started the merry chain of interventions that led to my c-section, another issue not mentioned in the discussion of inductions.
(heads up to @ICANtweets on Twitter for the original link, and to Jill for finding MomTFH’s information for me)
Reader Comments (33)
In the case of so many women I've talked to, hell even in my own pregnancy, that little seed of inductions is planted by doctors long before you even reach your 30th week of pregnancy. In my case, it was a causal mentioning of how big the baby was measuring to, "your baby is pretty big, lets schedule that induction". Even when I said, no way, I don't care if this kid comes out big enough to walk, I am not being induced, the doctor nodded, said okay. However when I was given a paper work at the reception desk on my way out in included ever so crafty hidden behind the paper on Cesarean Section Consent, a appointment slip with my induction date and time scheduled at my hospital. with instructions on what to do on my induction date. That was in my 28th week of pregnancy.
Now I don't doubt there are women out there who for whatever reasons, seek an induction at then end their pregnancy, however I have serious doubts they do so having had all the facts of the risks/benefits of inductions and in turn gave true informed consent. Nor do I believe these women seeking inductions represent the amount physicians would have us believe.
By the way, I did birth my baby, intervention free, 3 days after my due date (I ignored the first induction date, and didn't make it to the next one) and he was a nice healthy 9lbs 3oz. No complications, no bells and whistles.
I suppose it's one of those grey areas where no one will really ever know who requested or suggested what behind closed doors. What is discussed and agreed upon during prenatals doesn't always match up with billing codes.
From a doctor's point of view, there is something very appealing about scheduling births and controlling the unpredictable. Have you noticed that most patient struggles have to do with fighting for the right to the unpredictable. Sure, you can have the choice to opt for the controlled, managed procedure. Try asking for the opposite.
I'd love to hear more about the hospital's definition of elective.
I'm interested in the idea of "elective" as well, and what that would encompass. I know that I get told over and over and over that TRICARE won't pay for random u/s (thanks, don't want them) but if I'll just say I'm worried about movement, or worried about a baby too big, or have a history of _insert whatever_ then they'll pay for them because *then* they aren't elective, they're medically necessary. Weird. Then again, my backup midwife apparently thinks an induction would be medically indicated for me this pregnancy because I gave birth to a large baby, quickly, over an intact perineum, at home. I'm not sure where the "medically indicated" part comes in, but whatever - I politely (mostly) declined.
On the other hand, having been in the military spouse community for a while, I don't discount that there's an uptick in the number of maternally-requested inductions. I don't doubt that OBs plant seeds (especially at military hospitals), but I know a lot of women who try to plan births around R&R or deployments or whatever. With the force numbers being sent elsewhere, that's likely an increase in requests there, although clearly this is all speculation and anecdata.
I've long thought that it's kind of irrelevant that women are asking for inductions. As doctors, don't they have the ultimate ability to say, "NO. It's not medically indicated."?? They're really good at telling us NO on all sorts of other things that don't help us. "NO, you can't walk around. NO, you can't eat anything. NO, you can't push in any position other than your back. NO, you can't deny a c-section; we'll have to call CPS if you do." I mean, they're so skilled at saying NO, and yet they act like they wilt under mother's wishes every time when it comes to "maternal choice" inductions and c-sections. Seriously?!
Several women I know were pressured into an "elective" induction, and my cousin's wife didn't even bat an eye when they routinely scheduled her to be induced all three times. The first time it was because the doctor was going away for the weekend, and I don't think they even bothered to give a reason on the next two. And the thing is, they don't even try to deny that being induced doubles your chances of having a c-section. That alone should be reason enough to ban unnecessary inductions.
Augusta, word. SO MUCH WORD.
Augusta, do you have a blog? I want to read more of you! :D
Blushing here. Thanks, ladies. I do have a blog, but it's just personal stuff about my kids. :) I put it under Author URL.
The hospital is only limiting elective inductions before 39 weeks. I clicked on the article expecting them to be limiting all elective inductions and only allowing them for medically indicated reasons (which I wish the hospital had done). So women can still choose an induction for no medical reason; they just have to wait until they're 39 weeks along.
Loved how they point out concern that early babies lack coordination to suck - heaven forbid they actually educate the public in a news article and explain that it may interfere with breast feeding or even bottle feeding as if people who believe that 37weekers are 'done cooking' would some how get how important that is.
OMG. I heard this same story on NPR on the way to work one morning this week and almost wrecked my freaking car. Seriously, these are the same people who tell women they "can't" get out of bed, they "can't" eat or drink, they "can't" go more than x number of hours with ruptured membranes, and that they "have to" augment with pitocin, "have to" have an IV, "have to" get an episiotomy?!? But they're lamenting the fact that they, aw shucks, just can't stand up to those mean old pregnant ladies who are demanding non-medically-indicated and possibly dangerous preterm inductions? Oh yeah, that seems TOTALLY plausible.
How do you suppose I'd fill that in on my car insurance form? "Cause of accident: mainstream-obstetrics-asshattery-induced rage blackout"?
Exactly, Augusta. (love your name!) The media does such an excellent job of blaming mothers for everything. *sigh*
Rixa, I was hoping there was more to the story that just a 39+ week guideline. I wonder if it's worth a call to find out.
LOL, Laura Grace! I listen to NPR on my morning commute too - missed this story though. Its a good thing they don't run too many stories on "mainstream-obstetrics-asshattery" because I too would be tying up the Garden State Parkway with car wrecks!
<<The hospital is only limiting elective inductions before 39 weeks.>>
So essentially what we're saying here, is that this won't affect business as usual AT ALL. Because how many doctors do *you* know that admit they do *elective* inductions? Ask any individual doctor, and all the ones *s/he* does are necessary (and billed that way, for sure). I'm curious where all these doctors are that are doing elective inductions, after all...I'm sure there are a ton billed that way if it's as common as they're saying, right? Just like for c/sections?
And Augusta and Laura Grace, applause :-)
I wish they'd stop blaming women...if they emphasized the risks of inductions like they do the risk of VBACs, I'm guessing less people would get inductions than even VBAC.
Great post, Jill! I had the same reaction to a recent Green Journal article. I wrote about it here: The "Patient Push" for Early Birth: A Dangerous Concept or Valid Point? http://acnm-midwives.blogspot.com/2010/01/patient-push-for-early-birth-dangerous.html
ANaturalAdvocate, interesting question about planning births around deployment. Makes sense to this former Navy brat.
Emjaybee can take credit for the post. :)
I think, at least from my experience with ladies around me, that maternal-requested induction is probably quite common; at least, a lot more common than that elusive maternal-requested elective cesarean that hides out there somewhere in the obstetric jungle and eludes detection. But, I think the fault lies with the fact that induction is not discussed in a "risk/benefit" sort of way. I mean, of COURSE I'm going to request an induction at 38, 39, for sure by 40 weeks when I've out-grown my maternity clothes and my back aches and my pupps rash is driving me down a one-way street to the looney bin and I lumber into the doctor's office and he shoves his hand up my hoo-ha and says, "Wow! You're not dilated at ALL! We need to get things started here," and tells me all about how pitocin is "just the same thing my body makes," but never tells me that an induction will raise my risk of c-section, a premature baby, a baby with respiratory difficulties, the need for an epidural (with all of THOSE untold risks), etc., etc. Based on the information my trusted doctor is giving me, why WOULDN'T I ask for an induction?
Interestingly enough I had a friend give birth at this very hospital 2 weeks ago. A doctor ordered induction at 38 weeks. Another friend gave birth there and was induced at 37 weeks ending in a c/s a few months ago. I guess it doesn't count since they weren't elective. Megan- you are absolutely correct, this affects their business in no way. It looks like an article directed only at blaming moms. It also tries to put a positive spin on the hospital itself. It appears at first glance to be more friendly toward a natural birth approach instead of medical intervention. It doesn't take much reading to see through that pretty quickly. BTW, "mainstream-obstetrics-asshattery," is my new favorite catch phrase! Thanks Suzi.
The more I read about Obstetrics and Maternal care issues in the media the more I am convinced that we need to bridge the disconnect between what is actually "maternal request" and what is "Doctor-persuaded". Women trust their Doctor to suggest the best course of action for their health, not the most convenient, but somehow those two things have gotten mixed up. It irks me when I hear women talking so nonchalantly about their induction dates. It has become so normal, and that is just outrageous. My first was born by C-section, not because of induction but I believe because of a cascade of failed interventions. Now I am 36 weeks pregnant and finally doing the research and I realize that my body can do this, I was empowered by this knowledge that my body is not broken, and I dont "just have big babies". My mother and I still argue about whether my first baby's c-section was neccessary or not, but there is a part of me that knows if I hadnt been so trusting of my doctors things may have turned out differently. It amazes me that it can be so convincing to believe that this 30-40% c-section rate is neccessary, and I dont even want to know what percentage of women are unneccesarily induced... Grrrr, sorry for the rant, some days I just wish I could knock people upside the head and help them see the whole picture.
I really wish I could shout from the rooftops to all the pregnant women out there that induction is not the answer, no matter how convenient it sounds.