Tuesday, December 01, 2015

Having a Baby in Time for the Holidays is Elective Induction of Labor

The holidays are here!

Family comes and goes!

Your client is in her “due zone”.

Your client begins asking about being induced so she can enjoy the holidays.

What will you say to her?

In our profession, we read nearly every day about the cautions that need to be taken with
induction of labor.  Childbirth Connection defines elective induction as “induction without a well-supported medical reason”.  The holidays definitely fall into the category of non-well-supported medical reason for an induction.

Here are some suggestions to helping your client:

  • Your body is built to grow this baby and knows when the baby is read to leave the protection of the womb.  Trust your body.
  • A large amount of brain growth and development happens during the last weeks of pregnancy.
  • As a mother-to-be, your job is growing a happy and healthy baby.  Just this once, select someone else to do  the job of hostess.
  • Delegate the jobs you need to do this holiday season.  Enjoy being pampered, especially now!

About the Research
This section is more for the professional.  Knowing the background and rationale of advising against an elective induction of labor can help add to the tips listed above.

According to the Clinical Guide from the AHRQ (Agency for Healthcare and Quality www.ahrq.gov), among women undergoing induction, women with their first pregnancies have a higher rate of cesarean delivery than women with prior vaginal births.  This means that instead of having an induction and going home in a few days to enjoy the holidays, mothers often stay longer and have a much longer and somewhat more painful recovery.  The AHRQ goes on the say that a potential harm of elective induction of labor is unexpected prematurity. 

The Association of Women’s Health Obstetrics and NeonatalNurses (AWHONN) has also issued a statement cautioning elective induction of labor stating that induced labor is associated with an increased risk of hemorrhage when compared to spontaneous labor.  This risk factor alone is responsible for an increased risk of blood transfusion, hysterectomy, longer hospital stay, more hospital re-admissions and cesarean survery.  For infants, AWHONN states that induction can result in more fetal stress, respiratory illness, separation from the mother, interrupted bonding and less breastfeeding.

In 2013, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine reemphasized their position against deliveries before 39 weeks, unless there is a valid medical indication.  In their statement titled “Early Deliveries without medical Indications: Just Say No”, ACOG and SMFM urged members to reduce the number of nonmedically indicated early-term births and improve newborn outcomes.  Their patientFAQ restates many research findings in laymen’s terms.  Other organizations such as the American Academy of Family Physicians, the American Academy of Pediatrics and The JointCommission, a US based organization that accredits more than 20,000 health care organizations and sets standards for care,  concur.

And most recently, in the December 2015 issue of Obstetrics and Gynecology,  research shows that the cesarean delivery rate in the early induction group (with a Bishop score of 5 or less), was 30.5% vs the expectant management group of 17.7%.  This demonstrates that while elective inductions are done, the outcomes may not be what the expectant mother (or her family) anticipated.

It can truly be difficult for some expectant women to see past their own need for control of the pregnancy and the holidays.  With a compassionate and non-judgemental attitude, we should present the information in many forms and then allow the “informed decision making” process to take effect.

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