Under revised guidelines released recently by the nation’s association of obstetricians and gynecologists, physicians are being advised not to induce labor for non-medical reasons prior to thirty-nine weeks into a pregnancy. These guidelines, which are the first to be released since 1999, arrive after concern about the increase in the numbers of these procedures in the last twenty years; in 1990 the rate of induced labor was 90 per 1,000 births, however, this number increased to 225 per 1,000 births in 2006. The guidelines also describe when and how to induce labor in clear-cut medical situations, such as an irregular fetal heartbeat.
The guidelines are non-binding, but could be interpreted to hold the doctor liable if something goes wrong. Over the years, physicians who induce labor early for their patients’ convenience, as opposed to health concerns, have become commonplace. Patients often request early induction because they are tired of their pregnancy, want to make sure their doctor will be on duty to deliver their baby, or want to time their delivery to most efficiently manage their time off of work. While the guidelines take no position on these “soft” reasons for inducing labor, they do stress for the first time that mature fetal lung testing before thirty-nine weeks gestation by themselves are not enough to justify inducing. The guidelines also call for a physician who is capable of performing Caesarean sections (C-sections) to be on hand if inducing does not produce a successful vaginal delivery.
While many hope the consequences of these guidelines will lead to a reduction in the rate, a Houston ob-gyn called the new guidelines “lax” and was skeptical of whether they would have a significant effect. Many physicians feel a stronger statement needs to be issued to get hospitals on board. Although induction is relatively safe, it is being tied to the increased risk of C-sections; studies also found induced labor leads to higher medical costs due to longer stays in hospitals.
There is no specific number for the rate of inductions performed for non-medical reasons; studies have put it from 15 percent to 55 percent of the total number.