Induction and Prematurity

Some women may prefer to have an induction, even without medical need. Inducing labor may appeal to both the woman and the health care provider because it helps them plan their schedules. The March of Dimes recommends that labor be induced only when the health of the woman or baby is at risk.

In 2003, labor was induced in 1 out of 5 deliveries in the United States. The rate has more than doubled since 1990. Some health care providers believe that many inductions are medically unnecessary.

--- March of Dimes

http://www.marchofdimes.com/pnhec/240_20202.asp

Statistics for 2007 will likely be more higher than in 2003. I am against induction for many reasons --- 1) induction disrupts the baby's physiological need to begin labor as baby is known to send hormonal message to mother's body to begin labor; 2) induction requires epidural anesthesia for the mother's pain because induced contractions are "horrific" while natural is usually manageable; 3) baby gets the narcotic drugs as well; 4) there is no rest for the uterus or the baby and baby is forced through the birth canal and process; and 5) this creates a dynamic in the personality of the baby and in his or her relationship with the mother; and 6) induction is attributed to increased cesarean rate; and 7) Induction is also connected to the increasing prematurity rate.

I have been on a tear about the use of narcotics during birth and these drugs not being show safe for the birthing baby BEFORE using them and now promoting them as safe. I am thinking about prematurity and wondering about the science that tells us how long a baby ought to gestate. I don't know. I am going to be researching this. All I know is my own personal experience and watching a lot of babies over the past thirty years, but very closely for the past eight.

What is going on? Thirty years ago no baby was born before forty weeks unless it was initiated by the baby or clearly medically necessary. My older daughter was "due" on November 13th and born on November 30th. Seventeen days late and she weighed 7#7oz, the smallest of my four babies. No sign of post-maturity. In recent years I have thanked God, Jesus, and Mother Mary for not having to deal with the medical environment that women do today. My daughter mostly likely would have been born five weeks prior and would have been premature.

My GI Joe was born on March 21st, Spring Solstice, one day early and weighed 7#15 oz. I had insisted to my old geezer, obstetrician that he would be born early because I had read that the Cosmos never give a parent two Aries children (their special!). My first son was a Aries. Not that I was even into horoscopes, but I liked the idea of not going late again. Isn't that why most women are so susceptible to the suggestions or demands of the physician to induce? We're big, we're tired of it. We are tired of people saying we're big and, "Haven't you had that baby yet?" (here's your stupid sign) which these days must be even more ridiculously early and the topic of discussion in the days of "OH, maw gawd? You are not inducing?" My first baby was born four days after his "due date" but I had gone in in pre-labor and was not sent home but was "augmented" they call it now, without my knowledge or consent. He weighed 8# exactly. My body grows pretty average size babies consistently.

My younger daughter was due, according to my calculations on January 6th. My cycle was extremely predictable my entire life. Because I was "high risk" at age 37 I had a Triple Screen test and it came back high likelihood of Downs Syndrome. I was sent to a hospital in St. Louis, four hours away for amniocentesis and "genetic counseling." I went kicking and screaming all the way insisting that I did not want an amnio and that learning whether or not the baby had Down Syndrome would make no difference to me. Prior to the amnio they did a sonogram -- first one ever, fourth child, and decided that I was not as far along as I thought so they said my hormones were not sufficient at the time of the test. WHO KNOWS?? if that is the truth, I wonder now. Regardless, they moved her due date to Feb. 3rd. This was not so convenient as we were scheduled to move from MO to Phoenix in mid February. A decision to induce was introduced to me and at that time, in 1994, a physician could not induce without a medical excuse and a family practice doctor could not induce without answering to a committee of some sort. I know this because in my work place there were four of us expecting a baby between January and mid-February - five, if you include the executive director's wife. The one with the latest due date was mad that her doctor, a family practice physician, who could not induce her, so she would be last. Interesting note -- the day I induced my daughter, well, the second day of inducing, one of my co-workers came in to the hospital in labor and our babies were born within an hour of each other. So, anyway, my daughter weighed 7#11oz and was two weeks early or was she two weeks late? I believe my original due date of January 6th was correct and that she likely would have been born within a short time had we not induced her on the 17th. She was born on the 18th. For an induced and epidural birth, it was a "good birth" -- in the nine to 5 time slot (3:18 pm), no need for other interventions (my body knew what to do by number four), and baby was alive and "seemed fine" (although she came out screaming as I had blasted her out). There were ten other people in the room. Anesthesiologist and resident, OB and two residents, two nurses (day nurse stayed), two pediatric students and her father. I wonder why teaching hospitals don't make larger rooms. I was checked by the OB who said I was ready. I was shocked as it was my first birth to feel nothing and be "ready". At that point, I realized everyone in the room was looking at my crotch. It is clear now that my daughter was not ready --- and, it had nothing to do with her needs and her process at that point, from anyone's perspective. I recall a clear moment of needing something -- privacy or time, a moment with my baby and her dad? It was all rolled into fuzzy feeling of not quite ready. It was like I needed a moment of ceremony or ritual or something. But the need to perform and get out of the spot light prevailed. Three pushes and she was here -- mad, and as I know now in pain from being forced from beginning to end.

There is no science to this as doctors play with dates and make observations afterwards -- based on the condition of the baby. "Oops, that one wasn't really due yet." and "Hmm.... maybe this one was due Jan. 6 -- do you think the test and sonogram could have been off?" My body is pretty consistent in building babies. My boys were close to "due date" and weighed within an ounce of each other and more than the girls. My girls -- I think -- went longer but weighed less. In decades, more than a century actually, wouldn't you think that obstetric science would have this stuff down to a, uh hem, a "science"? so we could really know? So every mother and baby would just cook to the right temperature and then pop out a perfect baby? My older daughter had given birth twice. The second one was well over a week past the "due day", a VBAC, and the fist one was breech on his "due date" so he was born by cesararean a few days later. She found it helpful in HERstory that she had been seventeen days "late" so she wasn't worried. Women born by cesarean don't know their body's physiological history. Meanwhile, there is no definitive understanding of any of these based on SCIENCE. It's all cultural -- a representation of technology, physician need, and cultural changes.

My teacher, Castellino, collects old obstetrics text book and some back to the early forties. He says that obstetrics goes in ten year cycles. I guess, just like fashion and other culturally driven fads and ideas. In the fifties women were expected to keep their weight gain under twenty pounds. My mother gained eleven with her first child and he weighed ten pounds. When I birthed my two older children and gained twenty-eight pounds I was on the verge of the big 3-0 and in trouble. The last months were a constant chiding by the nurse and physician and worrying about weight -- the time the baby needs to gain and mother needs to be nourished.

So, I am wondering, where are we in the current cycle? When I gave birth in 1975, 1977, and 1983 inducing prior to forty weeks was not even a consideration. A baby allowed to go over forty weeks is unheard of now, but back then forty-two weeks was considered safe and normal. I was born two weeks late -- and see how normal I am!? Fourteen years ago we were stretching the rules -- thanks to the gallbladder attack in late December that gave medical cause -- to induce at 37 weeks. NOW, 37 weeks to 40 is also considered full-term. WHO decides this and what research is it based on?

SGA babies may appear physically and neurologically mature but are smaller than other babies of the same gestational age. SGA babies may be proportionately small (equally small all over) or they may be of normal length and size but have lower weight and body mass. SGA babies may be premature (born before 37 weeks of pregnancy), full term (37 to 41 weeks), or post term (after 42 weeks of pregnancy).

http://www.harvardvanguard.org/info/content.asp?pageID=P02411

Even March of Dimes says 37-40 weeks is full-term. I suspect they are being conservative and politically correct. I need to see the research and scientific studies to see why it is that this has changed over the last twenty years.