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Birth Induction: A Message to the AMA » Women's Courage

Birth Induction: A Message to the AMA

March 3rd, 2011 by hannahky Leave a reply »

To the American Medical Association:
I write to you today to express my concern with the hyper-medicalization of maternal care in American hospitals and clinics.
I note with great disappointment that the US has come 41st in a 2010 Amnesty International ranking of maternal death rates around the world.  [1] One of the major influences here might be the rise in medical interventions in childbirth, including inductions, epidurals, episiotomies, and c-sections. Of course these are often necessary steps to save lives, and I absolutely advocate them in these cases. However, I find it hard to believe that the 32 women out of every hundred who give birth by cesarean in the US really needed it. Given that the risk of death following a c-section is three times as high as for a vaginal birth [2], I think this is a serious cause for concern and could be correlated with our maternal death rates.

According to a Congressional Budget Office paper from 2008, “Newer, more expensive diagnostic or therapeutic services are sometimes used in cases in which older, cheaper alternatives could offer comparable outcomes for patients. And expensive services that are known to be highly effective in some patients are occasionally used for other patients for whom clinical benefits have not been rigorously demonstrated.”
This is a pattern which seems especially strong in childbirth. The appropriate use of technology can be tricky in a process which is entirely natural yet can be quite life-threatening. But we must avoid relying so heavily on our safety measures that they become unsafe when inappropriately used.
Therefore, I urge you to take action to reduce doctors’ reliance on medical technology when it is unnecessary, and instead foster caring, personal interactions between birthing patients and caregivers. I would like to specifically address labor inductions, because they are often the first link in a chain of unnecessary technological interventions. But, I believe this is only one of many aspects of modern childbirth that needs re-evaluation in the medical community.

The rate of labor inductions has doubled since 1990, [4] although there has been no change in the size of babies, length of pregnancies, or incidence of maternal illnesses requiring inductions. The induction drugs Pitocin and artificial prostaglandin are known to cause more intense contractions, which can interfere with the flow of oxygen-rich blood to the fetus. This can result in fetal distress, associated with passage of meconium (fetal excrement) and breathing difficulties at birth as the baby inhales its excrement. Induction also results in higher rates of caesareans. [3]
For the mother, artificial induction is associated with increased postpartum blood loss and increased uterine rupture (though it is still rare). It also makes labor a whole lot more painful, often necessitating an epidural for pain relief. And an epidural can stop labor altogether. [5] Voilà! The case for another cesarian.
I really encourage you to educate doctors on these impacts. For women where induction is not warranted, I recommend increasing fetal monitoring in the late weeks of pregnancy to make sure there is no distress, and encouraging the trial of “older, cheaper alternatives” for induction: breast stimulation, castor oil, sweeping the membranes (which encourages the production of natural prostaglandins in the cervix), and even, yes, sexual intercourse– because semen is the most concentrated source of natural, harmless, prostaglandin! Researchers have found cervical mucus prostaglandin levels 10 to 50 times higher than normal after pregnant women had intercourse. [6]

I understand that pregnancy can have increased risks beyond 42 weeks, and do not advocate refraining from induction when there is clear evidence of fetal distress, placental calcification, or other indicated maternal diseases. However, I think that medical caregivers need to recognize that induction can be just as dangerous as the risk they are trying to reduce, if it is not truly warranted in their patients. Rather than relying on such procedures, I think it important for doctors or nurse-midwives to be in better communication with their patients, monitoring them regularly and discussing their options thoroughly throughout the pregnancy. I recommend that you require doctors in your association to meet more often with women who have surpassed their due date, but allow the pregnancy to continue normally. I ask that you require hospitals to do a better job of reviewing induction justifications, and bring educational programs on the associated risks to institutions where the rates seem unnecessarily high.

I think that this could really help create a safer, saner system of childbirth for mothers in America, and ultimately the resulting reduction in procedures could also save us quite a bit of healthcare spending. Win-win!

1. http://www.guardian.co.uk/world/2010/mar/12/amnesty-us-maternal-mortality-rates
2. http://en.wikipedia.org/wiki/Caesarean_section
3. Gaskin, Ina May. Ina May’s Guide to Childbirth. New York: Bantam, 2003. Print.
4. http://www.acog.org/from_home/publications/press_releases/nr07-21-09.cfm
5.http://www.whattoexpect.com/blogs/librarianmommyreferencebookonparenting/overdue-birth–saying-no-to-pitocin
6.http://www.ncbi.nlm.nih.gov/pubmed/2712911

Also consulted:
http://emedicine.medscape.com/article/261369-overview
http://midwifethinking.com/2010/09/16/induction-of-labour-balancing-risks/

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