Obstetrics is a specialty that is never without controversy and an MSNBC article entitled Hospitals to crack down on induced labors has stirred up the pot again.
The American College of Obstetricians and Gynecologists (ACOG) has recommended that labor not be induced before 39-weeks because of an increased number of babies born with breathing problems. A labor induction can be elective (i.e., done for the convenience of the patient or professional staff) or medically indicated to preserve the life of the mother or fetus. At my institution of residency training, an elective induction was not part of our vocabulary or armamentarium. Heads rolled and promising careers detonated right before our eyes at Harlem Hospital if someone induced a patient without a medical indication. But times have changed.
In my post-residency career, I have witnessed the new world order. Between 1989 and 1998 the incidence of elective inductions increased by 19%. Some colleagues performed elective inductions for reasons that were clearly suspect: physician vacations, not wanting a late-night surprise, or inappropriate patient requests. Not wanting your baby to be delivered on your ex’s birthday is NOT a justifiable reason. Granted, some women want to be induced because they’ve bonded with a particular physician who might not be on-call when they’re in labor. However elective inductions post the risk of having a c-section or a baby with breathing problems if the due date is incorrect.
So what is the right thing to do? A pregnant woman can be offered an elective induction of labor at 40 weeks ± 3 days, meaning 280 days after the last menstrual period if there is a 28-day cycle. It is also preferable to use an early ultrasound (before 14 weeks gestation) for accurate dating. If that’s not available, most physicians will wait no later than 41-weeks gestation for an induction, to avoid complications of fetal meconium , “old” placentas and big babies. If a health-care provider does not want to deliver by 41-weeks than the patient should clearly have non-stress tests to document fetal well being.
Bottom line: elective inductions will still be around, but there is now stricter scrutiny by hospitals in order to do one.