Thoughts on inductions before 39 weeks of pregnancy

I've been out of the blogging for awhile. Life kind of got busy. But today seems like a good day to share some thoughts.

The American College of Obstetricians and Gynecologists (ACOG) recently released a bulletin discussing inductions. Here we are referring to inductions of labor by the use of medications or mechanical devices that stimulate labor to deliver a baby. The new recommendations are that there should be no inductions of labor before 39 weeks of pregnancy unless there is a medical reason. "Tired of being pregnant" doesn't count on the mom's side. "It will interfere with my time off" doesn't count on the provider's side. In other words there needs to be something like a problem with the baby or a medical problem with the momma.

Here is where it gets tricky. There is politics involved. Some providers follow this standard very aggressively. After all the March of Dimes, a wonderful organization in the U.S. that is dedicated to healthy babies, has made it very clear that before the due date, at 40 weeks, there is a lot of brain development that still happens even when the baby is considered term at 37 weeks. I see pregnant women every week who think their 35 week baby inside is just as ready to be born as the term baby at 40 weeks. They imagine that the baby will be fat and healthy and feel nothing could possibly be gained by waiting another 5 weeks. Once I explain to them how much more growth the brain still has to do many of these moms then come to understand that waiting on Mother Nature is the right thing to do. But not all providers share this information with their moms. If it is more convenient to schedule an induction of labor because it makes their clinic time flow better or because they want their time off on the weekends not being bothered by having a laboring woman show up to care for, they will just schedule the induction. If that provider has some political clout in the setting they are delivering these babies in, they often get away with it. But that doesn't make it right.

What is new on the horizon? There are many hospitals now looking at implementing strict rules for when a woman can be induced. They will insist there be good dating criteria for how a pregnancy is calculated to be 39 weeks before an induction is scheduled. For example, how early was an ultrasound done in the pregnancy? The earlier in the pregnancy the ultrasound, generally the better the measurements can tell exactly how far along a pregnancy is and when the baby is likely to be due. Another measurement might be done by an amniocentesis at the end of pregnancy to see if the baby's lungs are mature. This is done by sticking a needle in the woman's abdomen and withdrawing some fluid from around the baby. An amniocentesis has its own potential risks such as accidentally nicking the baby with the needle or accidentally going through the placenta and causing bleeding. Most of the time an amniocentesis is done with an ultrasound to guide where to place the needle, but that still doesn't make it risk free.

Evidenced based care for pregnant woman and their babies is clear: inductions of labor before 39 weeks of pregnancy is not good care unless there is a medical reason or a reason such as the woman lives 2 hours away from a hospital. There are other reasons that make sense for induction, and this should be left to the provider and to the woman to figure out. The one piece I think is missing in the system of care we have now is who is double checking if this induction is good for the baby? Nobody. There is nobody in place as the system is set up now who will question this prior to the induction. I think the piece that is missing in the current system is the baby's advocate, be that the pediatrician or neonatologist or some other party that would have the baby's best interest at heart. I wonder if this will ever fall into place in our country? I wonder if there is anywhere out there that has this in place? I would love to know.