Earlier this week, MSNBC featured an article about Hospitals Across the Country soon implementing stricter guidelines in labor induction due to the rise in late term premature births, and the complications that can rise from these births. I would like to first start by highlighting the inaccuracy of calculating due dates in women. Many women feel as though their due date is D (delivery) day, and that the baby should be evicted before or on that day. Believe me, I was one of those women with my first child. The second time around I discovered how inaccurate they are, as well as ultrasound dating.
“A study has shown that an ultrasound isn’t any more accurate than a reliable menstrual history combined with a pelvic exam by an experienced obstetrician. Researchers confirmed this by looking at pregnancies with known conception dates and comparing due dates arrived at by ultrasound measurements with dates arrived at by menstrual history and pelvic exam. The fact that the old-fashioned method for dating a pregnancy does just as well as ultrasound is a vital point. While a sonogram may be useful in cases where there is uncertainty about when conception occurred, first-trimester sonograms are currently used as the ultimate standard. Your due date will often be changed if it differs from the one derived from the sonogram no matter how the date was previously determined or how sure you are of when you conceived.
Even first-trimester sonograms have a range of plus or minus five days, or a ten-day window, around the calculated date . The range increases to plus or minus eight days in the second trimester and plus or minus ten days for third-trimester scans. For this reason, experts say the due date should not be altered based on results from an early scan unless the calculated date differs by two weeks or more from the date determined by physical signs and symptoms and menstrual history.”
The above is taken from When Is that Baby Due?
Now, knowing that even with ultrasound dating, which we treat is the final method of determining a estimated due date, which I have noticed, everyone always leaves out estimated, because many feel the need to have that “end date”. There is still a 5-10 day window for that baby to be off. When taking this into consideration, babies that are being induced before 39 weeks gestation, could be mistakenly delivered at 35 weeks gestation, long before they are truly ready to join us. Another connection to elective labor inductions, as well as elective cesarean sections, there is an increased number in babies being admitted to the NICU for special care, most of the time for respiratory distress because their lungs are not ready or developed enough to work properly.
“1 in 4 inductions were before 39 weeks
National guidelines from the American College of Obstetricians and Gynecologistshave long discouraged elective deliveries before the 39th week of pregnancy. But some hospitals that took a close look were surprised. At Utah’s Intermountain Healthcare, for example, 28 percent of elective deliveries were breaking ACOG’s rule in 2001, Oshiro told a March of Dimes meeting on preventable prematurity this month.”
Above taken from The MSNBC Article previously mentioned.
What I have noticed in the past, maybe year, since really focusing more
on birth, labor, and the guidelines that ACOG puts into place, there
are a large portion of OB/GYN’s, Midwives, and Hospitals that ONLY use
the ACOG guidelines when it works for them. Now I am not throwing
around accusations, but if you look at the above example of this Utah
hospital, and then take a look at the current VBAC denial case of Joy
Szabo in Arizona, her hospital stated that they no longer will offer
VBAC birth services because of ACOG guidelines. When ACOG was reached
to be questioned about this statement and about their guidelines on
VBAC births, and ACOG Representative said that Page Hospital in Arizona
had interpenetrated their VBAC guidelines incorrectly, and still have
yet to make the chance according to ACOG’s guidelines on VBAC. Why?
Because it seems as though it is simply easier for them to ban VBAC and
be done with it. Even if it means women have to drive 300 miles to the
next hospital that will deliver a VBAC baby.
“Most were being induced in week 37, such a small difference that local obstetricians argued it wasn’t a problem. So Oshiro pulled the medical charts and found those near-term babies had more than double the risk of ending up in neonatal ICU, suffering respiratory distress, even needing a ventilator.
It took several years of policing: Inductions now are allowed only after meeting a checklist of requirements. But today, only about 3 percent of Intermountain’s elective deliveries occur before 39 weeks — and infant hospitalizations have dropped, saving money, too, says Oshiro, now a maternal-fetal medicine specialist at Loma Linda University in California. He’s about to pilot a similar program at hospitals in that area.”
While there are some medical reasons to induce birth before the 39th week of pregnancy where the benefits to the baby outweigh the risks, if you look at the above quote taken from the MSNBC article also, it shows that after guidelines were put in place at this specific hospital, only 3% of babies were induced before 39 weeks, and I will go ahead and assume these were for medical reasons.
What is not being mentioned in this article is that, over 40% of all birth inductions, necessary or non medically necessary end in cesarean section. In more recent years, birth professionals such as Marsden Wagner, and Robbie Davis-Floyd have estimated those numbers to be upwards of 50%. And in many cases, this large risk is not discussed before labor induction. The reason for the large cesarean section numbers with induction is because the body is simply not ready to give birth no matter what kind of medical interventions, medications, or technology you use. In most cases the reason for these cesarean births are labeled as “failure to progress” which is obvious because the body is simply not ready to birth the baby, because the baby is not ready either. Again, when medically necessary induction and cesarean sections are lifesaving to mom and baby, just not at the large numbers we are currently seeing in our country.
In the year 1990 1 in 10 labors were induced, and today, 1 in 5 are
now induced, that is nearly double in the span of 20 years, with no
medical reason backing this up. I can say, while I was rather young in
1990, the birth climate has drastically changed in many ways since
then, inductions being one of them. It seems as though inductions, and
cesarean sections scheduled for convenience factors did not nearly take
place as much as they do today, 20 years ago. If you go back another 15
years from 1990, you see actual breech births being done in hospitals.
You can say there has definitely been a huge change, but then we have to ask ourselves, has it been for the better?
Last I will address defensive medicine which is also mentioned in this MSNBC article.
“Patient and doctor preference helped drive the rise in inductions, such as women timing grandma’s arrival to take care of the siblings, or minimizing 3 a.m. deliveries. Then there’s defensive medicine, where doctors worried about litigation induce for minor reasons like a slight uptick of the mother’s blood pressure.
So Pittsburgh also had “a little bit of a hard sell” after discovering nearly 12 percent of elective deliveries broke the 39-week rule in 2004, Fisch says. “It was perceived to be a safe and effective way in delivering a baby — and it is, as long as it meets certain criteria.”
After Magee began strict enforcement — requiring that a mother’s cervix be nearly ready for natural labor, and limiting the beds available for elective inductions — too-early inductions dropped to 4 percent by 2007 and are “effectively zero” today, Fisch says. Overall, elective inductions dropped 30 percent.”
Minimizing 3am deliveries? I guess it was just silly for me to expect someone like a Doctor, or a Midwife, to attend deliveries no matter what time the birth is. If you are concerned about being woken up in the middle of the night because a woman is in labor, maybe you should have gone into a field other than Obstetrics?
Again, I go back to the question…. Has birth really changed for the better?
Lastly I will say…. FINALLY! Good for these hospitals FINALLY cracking down on this!
It is about time!
Taken from http://blog.ctnews.com/elwood/
Good. Birth should NEVER be centered around CONVENIENCE! Inductions should only happen when they are truly necessary which I'm sure isn't any where near the amount that happen.
- mommypip
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