Part 1 – Exploring the Reasons for Increasing Inductions Today
The Statistics of Labor Inductions
There has been a dramatic rise in the labor induction rate in the last 15 years. According to the National Center for Health Statistics, the rate of inductions was 9.5% in 1990. In 2003, the rate more than doubled to reach 20.6%. There is reason to believe that the most current labor induction rates might, in fact, be under-reported.
According to a review of 7,000 consecutive inductions, published in the American Journal of Obstetrics and Gynecology, (the Green Journal) the number of labor inductions may be closer to 40% in some community hospitals. Similar findings were reported in Listening to Mothers survey. Of the nearly 1600 mothers interviewed, 49% who gave birth vaginally reported that their medical provider attempted to induce their labor and 44% actually had their labor induced.
Questions about Labor Inductions
What are the reasons for this dramatic rise in induction rate? Are more mothers choosing to be induced? Are more physicians recommending labor inductions to their patients? Are there compounding medical reasons for this increase? Is the rise in labor inductions contributing to the increase in the cesarean rate? Are there additional risks to the mother or baby from labor inductions? Do women have a choice not to have their labor induced if there is no indicated risk? Are there benefits for mother and baby to waiting for spontaneous labor to begin?
Exploring the Answers
One possible reason for the rise in labor inductions in the last 15 years is the current age of convenience. One look at the success of fast food and drive-thru restaurants indicates that we are consumers who demand speed and availability. Processed foods that are microwaveable are often preferred over a meal that takes all day to simmer. Is it no surprise that we would be tempted to schedule a labor induction at a convenient time that might be shorter, rather than wait for spontaneous labor that could take days or arrive at an inconvenient time?
Another possible reason for the increase in inductions is the number of physicians in obstetric practices in the last few years. Gone are the days when women visit only one provider throughout their entire pregnancy. Many women do not have the chance to get to know 4 or 6 or even 8 different physicians, yet there are many obstetric practices today which require that the mother see every obstetrician.
In fact, 1/3 of the women in the Listening to Mothers survey reported that they had never met or barely knew the doctor who delivered their babies. Scheduling a labor induction allows the mother to “pick her provider” as well as the day of her baby’s birth. Be sure to read Questions to Ask your Provider to help you get to your own provider.
Military families with one or both parents in active duty are very likely to opt for a labor induction. Planning a labor induction is desirable over waiting for spontaneous labor for many military families since women would want to have their spouses or partners present, and inductions would guarantee that.
There may be other reasons why more women today could be choosing inductions, including the career demands of both parents, limited maternity leave, travel distance between home and place of birth and preferring a day time labor as well as the discomforts of late pregnancy such as back pain.
Some providers may recommend an induction to their patients for a number of reasons. One reason might be the suspected size of the baby. The difficulty in late pregnancy is accurately predicting the baby’s size since ultrasound measurements are based on percentiles. These percentiles measure the “average weights” of babies, however the estimates are not always accurate.
For example, one of my doula clients had an ultrasound that estimated her baby’s weight to be 9 pounds. One of the measurements used is the length of the femur, which is the bone in the thigh and also the longest bone in the body. It turned out that her baby’s weight at birth was only 6 1/2 pounds since he had very long, skinny legs!
Another reason for a provider to advise an induction is when the mother’s due date has passed. Babies who are truly post-term can have more complications. However, this diagnosis must be made based on more than simply dates. Specific testing can be done, such as a biophysical profile, which measures the amount of amniotic fluid in the uterus, the breathing movements and the baby’s heart rate. This would give the provider and parents a more accurate indication of a post-term baby (and ultimately a labor that needs to be induced!) rather than looking at the due date alone.
It is important that parents take the time to discuss all of their options with their provider before any procedure is recommended.
Be sure to check out Part II of this article including whether or not inductions affect the cesarean rate and questions to ask your doctor about labor inductions.
Do you plan to be induced? Why or why not?