6.23.2010

What A Difference A Week (or two) Makes


With the rate of inductions being so high in the United States, the question is raised of, beyond maternal and birth risk, what additional risks are there for babies immediately after birth and long-term?

Babies Born at 37-39 weeks gestation are at an increased risk of autism or an SEN (Special Education Need). It was already known that children born very premature were at increased risk for this, but, until just now, no research had been done on closer-to-term infants. The findings report that these babies, babies born between 37-39 weeks gestation, are 1.16 times more likely than truly full-term babies to develop autism or another SEN.

Additionally, children born earlier are at an increased risk for newborn death, respiratory distress, and modestly lower IQ scores.

An interesting bunny trail regarding this particular article is that, although the article points out many risks for babies born prematurely, as well as Dr. Michael S. Kramer pointing out that
..... both obstetricians and women should be aware that labor induction at the 37th or 38th week is not without risks. And studies should continue to examine the potential public-health impact of the rising labor induction rate.

He is careful to include the comment that:

"I'm not saying we're at the point that we're doing too many labor inductions," Kramer said. But if the rate continues to increase, he added, "eventually, we may get to the point where we do more harm than good."

hmm... so, even though the induction rate is at or above 22%, and...

Precisely why labor inductions rose between 1992 and 2003 is not known; Kramer's team had no information on the medical reasons for individual women's inductions...

... he is sure to point out that he is not saying that they are at the point that they are doing too many inductions! Even though those inductions carry obvious risk and the rates are still climbing. Hmm...

I digress... So, all of this to say that there is a great wealth of supporting information and studies to show that we are, indeed, introducing unnecessary risk when we induce women without valid medical reason: when benefits CLEARLY and COMPLETELY outweigh the risks.

I cannot stress this enough. You would not believe the number of women who succumb to an induction because they were 'told they had to if they wanted a chance at a vaginal birth', were 'told their baby was due and now we were risking things by allowing baby to stay in past (supposed) 41 weeks', or were 'told that the baby was getting too big for a vaginal birth unless we have them now'. And on and on...

When we cannot truly know when a baby is truly due based on the gestation wheel alone, and we cannot meddle in nature without increasing risk to begin with, the question is raised, "WHY do we continue to allow early inductions without valid reason?"

A Good Reason is NOT:
  • big baby
  • supposed due date
  • slightly elevated BP close to the due date
  • edema close to the due date
  • schedule conflicts
  • low fluid levels close to the due date
  • family in town
  • convenience
A good reason is when the medically sound benefits of getting baby out of the womb OUTWEIGH the risks of a possible early induction (again, because we cannot know beyond a shadow of a doubt how 'due' a baby truly is until they are born) combined with the risks associated with induction (regardless of when it is performed).

I think it is high time that we start to really consider how much faith we put in human interference versus nature's design.

5 comments:

Myndie said...

Thank you for sharing this! I always wondered why women don't just wait for the baby to be ready.

Chri-Chri said...

Thank you, thank you!! I agree that we are interfering too much based on convenience sake. This process is a perfect science created by God and we should not mess with it. I was preeclamptic with two of my children and believe induction was best for both of us, although I hated having to go through it. However, my son was full term and 11 lbs. 2 oz. (NO gestational diabetes) They induces 3 days early based on a blood pressure peak and honestly, I probably should have had a c-section. He was born with a broken collar-bone and my body never fully recovered. This is such a touchy issue when you are dealing with a human that you can't see or examine to know for sure what you are working with!!

AJ said...

ctually having a Big Baby is an excuse, my friend came out at 13lbs 4 oz and because of his size his mother bleed out and died minutes after pushing him out.

Chri-Chri said...

I'd probably have to agree with AJ. I didn't make my point well in my above comment. I was trying to say that inductions for "convenience" reasons or for things reasons wherein the risks don't outweigh the risks of induction, I think happen too often. But, I believe there are times when it needs to happen. At 39 weeks, I was measuring 42 weeks and I could no longer walk I was in so much pain. As big as my son was, he was in danger of brain damage, among other things (like the broken collar bone) and so was I. I had a LOT of bleeding as well, after. Thankfully, we made it out okay. The decision to induce is not an exact science. And, I was told then that his size was not a reason to induce. They had to wait until my blood pressure was high to have a "medical reason" to induce my labor. That was in 2003 and I was told that they were really cracking down on inductions and C-Sections at the time.
The bottom line is this. It was my second pregnancy and I KNEW something was not right. It felt different than before. I cried every time he moved his head or any time I had to really move or walk. I can't imagine if I'd carried him much longer.
It's a fine, fine line. Because the doctors can't induce every woman who walks in at 39 weeks to say she's uncomfortable, hurting, and ready to be done. But then there cases like mine where my doctor aplogized profusely afterword for letting me have him vaginally and waiting so long.
However, I will say that I had an amazing midwife who allowed me to listen to my own body during delivery and only push through the contractions that I felt the urge - not making me push if I didn't feel it. And, I had that 11 lb chunk without tearing!! Our bodies are amazing! And, they're made to do this!

Nicole D said...

AJ and CriCri -

"So, all of this to say that there is a great wealth of supporting information and studies to show that we are, indeed, introducing unnecessary risk when we induce women without valid medical reason: when benefits CLEARLY and COMPLETELY outweigh the risks."

Again, see the point that I have made about it being a VALID medical reason? There are phenomenal doctors out there who can be trusted to give accurate information on when baby is TRULY macrosomic.. but those are, unfortunately, too few and far in between.

Routine induction for suspected big baby (like, saying the baby is between 8-10lbs) is NOT a big baby, and 'overdue' by the Naegele wheel guesstimate is NOT accurately overdue.

CriCri, I love your statement, that your induction resulted in a beautiful big chunk of baby love and you did it without tearing... and you are sooo right, our bodies are made for this and they ARE so amazing!

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