Many American hospitals and Obstetricians have put a “hard stop” on elective labor inductions. As a result many hospitals and physicians are seeing a significant drop in still births, NICU admissions, cesarean sections and post partum hemorrhage. Data presenting the effects of such hospital practice policies was presented at the American Congress of Obstetricians and Gynecologists (ACOG) 61st Annual Clinical Meeting.
The United States has long been noted to have adverse birth outcomes that, in some instances, rival those of developing nations with far fewer resources. With the world’s eye upon us, many hospitals adopted a no elective labor before 39 weeks gestation policy. This means that under no circumstances is a mama to be induced before 39 weeks gestation unless it is absolutely medically necessary; there is danger to the life of mama or baby. Otherwise, Mamas and babies have to “tough it out” to term. Additionally, many hospitals are adopting strict policies against obstetricians who perform elective inductions in an effort to deter the practice.
The results of the policy has shown the following results according to researchers Nathaniel DeNicola, MD, from the University of Pennsylvania, in Philadelphia, Andrew Healy, MD, medical director of obstetrics at Baystate Medical Center, in Springfield, Massachusetts and Angela Silber, MD, director of maternal-fetal medicine at Summa Akron City Hospital, in Ohio:
Dr. DeNicola’s Study (A Survey Study)
- Many hospitals have adopted specific policies against elective induction
- Nearly two thirds of more than 2600 hospitals have “no elective induction” policies in place.
- 67% of hospitals have a formal policy against non-medically indicated labor induction, and among those without a formal policy, just over half said it was against their standard of care.
- 69% of formal hospital policies were hard-stop, meaning strictly enforced, as opposed to soft-stop or strongly discouraged.
Dr. Healy’s study
- Compared 9515 singleton births before the policy and 2641 singletons after the policy found a significant decrease of 5.9 hours in the median time to delivery (P = .002).
- The cesarean section rate for elective inductions also decreased from 16% before the policy to 7% after (P = .05).
- NICU admission rates decreased by a third. Before the policy, 3% of term babies got admitted to the NICU and after the policy that went down to 2%” (P = .02).
- No increase in the stillbirth rate
Dr. Silber’s pre- and post policy comparison
- Decrease in stillbirths and NICU admissions
- Comparing 9806 singleton deliveries before the policy and 6041 singletons after, the number of stillbirths decreased significantly from 16 to 3 ( P = .023), with a trend toward significance in the reduction of NICU admissions (from 867 to 587; P = .06).
- There was no significant difference in macrosomia (Large for gestational age) rates (P = .718)
Other data not fully analyzed shows a decrease in cesarean sections as well as postpartum hemorrhage.
As a result of these studies, many obstetricians and hospitals are really questioning the practice of induction and no longer performing inductions unless absolutely medically necessary. According to these researchers, this data may be what makes elective inductions history!
Summarized from MedScape News, OB/GYN & Women’s Health by Kate Johnson, May 23, 2013
What is a “normal birth”? The definition of a normal birth varies. Using the broadest of definitions, “Normal Birth” is defined as the spontaneous initiation of the birth process, i.e. uterine contractions and cervical dilation and effacement occurring between 39 and 42 weeks of gestation. That is the broad, baseline definition. But this has varied over time. If you ask someone who delivered back in the 1920′s, they defined a “normal birth” as a home birth with a local midwife. If you ask someone in the mid to late 1950′s, a normal birth is a hospital birth, likely in a ward and with lots of medications and monitoring and a mama who may or may not have been conscious during the process. And today, the definition has become even more broad and varied. What is comes down to is this; “normal birth” is relative. What was normal in the 60′s when I was born is not at all how “normal birth” is defined today.
What about complications? How do they play and if they arise, do they negate a birth from being “normal”. This is the central question addressed in this video blog. Mamas, if complications arise during labor and delivery, that doesn’t mean that the birth isn’t “normal” and more pointedly, it doesn’t mean that you, mama are a failure.
Good Morning Mamas!
I have a good friend who is a doula and she is passionate about what she does. She recently attended a birth that lasted over 36 hours and although it resulted in a beautiful, healthy baby girl, the new mama was saying-out loud and in the presence of her daughter-that she was a failure because she had succumbed to an epidural and she was sorry.
My friend immediately reminded this new mama that there was no failure in this birth. This mama held in her arms a beautiful, full term, healthy baby girl. She had endured 36+ hours of labor and had indeed pushed her daughter into this world via a much desired vaginal birth. She was in no way a failure because after some 36 hours this mama reached the end of her physical rope and consented to and received an epidural. In viewing her use of an epidural as a failure, this mama discounted all of her intense and yet beautiful labor and delivery.
We humans are peculiar creatures. I believe that we are the only creatures in the animal kingdom who can get caught up in our one shortcoming that we discount the other 99 things that we do right! I don’t know this woman, but I do know that she had an uneventful pregnancy, was term at the onset of labor and just gave birth vaginally to a beautiful, healthy baby girl. She worked, toiled and labored for 36+ hours. She did it all. It was only at the very end that she needed a bit of assistance and she received it. For that one tiny (shortcoming) this woman saw herself as a failure.
Mamas, I know that many of you may read this and think,
“She’s complaining because she had an epidural?? Well, I can show her failure! I’m here on bed rest and at risk of losing my baby! The most basic and most natural of things for a woman to do, to become pregnant and to deliver a baby and my body has betrayed me. I am a failure as woman.”
These may not be your exact words, but am I close? How badly have you “shred” yourself because you are on bed rest? How many times have you believed and/or called yourself a failure because you ended up on bed rest? How many of you feel betrayed by your bodies? Feel broken or less than a woman?
I hear you. I see you. I feel you. I hurled many of the aforementioned statements at myself when I lost my 2 pregnancies and as I struggled to have my daughter. I felt completely broken and useless as a woman. Who or what was I if I couldn’t have a baby? That is what women do, make babies! While I was very conscious of the fact that many women lead very full lives without children, I also knew that this was often by choice, not by circumstance. I wanted to have children and it felt as though the universe was playing a painfully cruel joke on me.
When my friend told me about this birth, giving me graphic details of the labor and delivery as well as this post partum self depreciation and how she responded, it really drove home to me that there is never failure in pregnancy, labor and delivery, only perfection.
Every birth is perfect and that includes the “good and ethereal transformative” experiences as well as the bad and really ugly! I have no idea what will happen in the life of this new mama, her baby girl, her husband or her mother. But the fact that they are all there at that “serendipitous” moment makes it exceedingly clear to me that there are lessons to be learned.
Sometimes, when I allow myself, I play a little round of “What If?” What if I had gotten married younger? What if I had not miscarried? What if I hadn’t had uterine fibroids or luteal phase defect-the causes of my miscarriages. What if….?
Perhaps if I had gotten married younger I wouldn’t have had the problems that I had. Maybe. If I had not miscarried, I would have 2 entirely different children as each miscarriage preceded one of my children. While I am sure that I would love any child that I had, I really can’t imagine not having the kids that I have now-quirks and all! And if I hadn’t had all the problems that I have had, I never would have started Mamas on Bedrest & Beyond. I never would have been seeking answers for what was “wrong” with me, how to fix it and how to help other women avoid the pitfalls that I faced. So for all of my failures, I have had bountiful success and joy!
Mamas, it’s perfectly normal to be disappointed when things don’t turn out the way you expect. But just because the outcome is unexpected, doesn’t mean that you are a failure. Every pregnancy, labor and delivery occurs in its perfect time, place and sequence. What you may be regarding as failure may in fact become your greatest triumph! In pregnancy as in nature, there is no failure, only perfection.
Please share your comments in the section below of how you can see the perfection in your situation. Even if you can’t imagine the perfection now, how are you looking forward to it?