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Making the Choice : Elective V. Medically Necessary Inductions

Spooky season may be over but there’s something even scarier approaching!!


That is the rise in non medically necessary inductions due to the Holidays. This is a long discussed issue we see continue. We now have a better idea of what risks come with inductions. My goal with sharing this information is to allow parents to make the best educated decision for them and their baby! 


Today I'll share three important topics to understand;  the increased rate of inductions around the end of the year holidays, the difference between a medically necessary induction and an elective induction, risk/benefit analysis of inductions. 


The statistics on Inductions around Holidays


Thanksgiving, Christmas, New Years etc are all not Medical reasons for an induction. However we consistently see more and more stats on how this time of year the induction rate significantly increases. Lets just hop right into them:

  • The Journal of Labor Economics found “18% fewer births on the day of and just after a holiday. Cesarean sections account for roughly half of the decline. “Missing” holiday births are displaced to a window of time 11 days before the holiday through 16 days after the holiday. “ 

  • The least number of births in the US happen on: December 25th, followed by January 1st, then December 24th & July 4th.

  • The AAFP reported ‘The rate of induction in the United States (23.4% of all births) has more than doubled since 1990’.




Reasons for Inductions 


Non Medically Necessary Reasons: 

  • Baby is getting ‘too big’ 

  • Your Placenta is getting old 

  • Fluid is too high or too low

  • Your baby is ready between 37-39 weeks

  • Your baby is at an increase risk for still birth after 40 weeks 

These are just some of the reasons given to mothers in order to get them to agree to an induction or at least schedule it. When faced with these reasons its crucial to ask:

  • What symptoms or signs am I showing to support this claim? ‘ 

  • If I schedule an induction will it be listed as elective or medically necessary’. 

  • What happens if we wait and do nothing till my next appointment? 


Medically necessary reasons for inductions:


  • Preeclampsia 

  • Increased bleeding

  • Uncontrolled Gestational Diabetes

  • High blood pressure & fetal distress 

  • Decreased fetal movement 




Risk/Benefit analysis with elective inductions


Risk:

  • Early birth:  Estimated Due Dates are just that, an estimate. Which brings the risk of being induced and having a baby that isn’t fully ready for life outside the womb.

  • ‘Failed Induction”: An induction that ends with a C section after 24+ hours of labor.

  • Length of induction: It is not completely uncommon for moms to have 36 hour inductions. This is more common the earlier you are induced and typically because your body isnt fully ready. 

  • Low Fetal Heart Rate/Fetal distress : There are several ways to be induced but one common theme seen in inductions is fetal distress with the introduction of Pitocin.

  • Affects of Pitocin: uterine tachysystole, fetal distress and the need for c sections

  • PROM leading to Infection: When your water is manually broken it increases the risk for infection for mom and baby. This also puts you on a sort of ‘timeline’ to deliver because as time moves on the increase of infection along with cervical checks increases. 

  • PPH (Post Partum Hemorrhage): One of the leading causes of death related to pregnancy is PPH. Moms who are induced are at an increase risk of PPH. 

  • Increased Monitoring: Inductions are intense, the surges are strong and approach quickly. Moms tend to need more monitoring during inductions for her and baby, leading to them being stuck in the bed and moving much less. 

  • Placenta Implantation Abnormalities with future pregnancies 

  • Hospital Readmissions

  • Higher risk of C section (50% for First time moms and 30% for second time moms) 

  • Increase desire for Epidural 


Now that we have a better idea of some of the risks let's look at some benefits of Elective Inductions.

Benefits:

  • Often successful with low risk pregnancies 

  • Moms with higher BISHOP scores tend to have smoother inductions 


There aren't many positives that can be proven with statistics right now. However, that doesn't mean there aren’t positives like; having inductions planned during a period when family is around to help. For some families they work and that is okay. 


When providers offer inductions without medical need, you could be walking into a very risky situation. Things to consider would be your BISHOP score, reason for induction & risk/benefit analysis. As a mother & parent you deserve all the information to make the most educated and informed decision. I hope this quick blog helps you navigate your decision with confidence and NOT fear. Whatever your choice, I am sending you heaps of love and support! You are incredible mama!!





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