• patrice

    When I was pregnant with my last son (who is now 16months), I distinctly remember having a long conversation (long because I basically had to hold my doctor hostage) regarding inductions. It was around my 36week and I remember for a few weeks tossing and turning at night thinking about how I felt I was already being set up for one. I kept being reminded during prenatal checkups that it was looking like I was going to have a “good sized” baby and finally that term was replaced by large baby. And so I decided I wanted to let him know that I absolutely did not want to be induced because of suspicion of a large baby, or an estimation. He assured me that if all things were healthy, I was fine, baby was fine, no induction would be scheduled. Of course, at my 5/8/08 visit, I got a paper scheduling my induction for 5/21/08. That was a week after I was due, my due date being 5/13/08. So already, just a week before my estimated due date, I was scheduled for an induction only a week after my estimated due date. There was nothing medically indicating the need for an induction, I’d already spoken to my doctor about my views on it and yet there it was in black and white, feeling to me like a curse! I was, needless to say, a little perturbed. Not only did I have anxiety regarding induction for the rest of my pregnancy, I also took those negative feelings with me into labor (which started on it’s on May 15th) and when it was time to push a visualization of a super large baby popped into my head. I saw my baby not being able to fit, getting stuck somehow, not breathing and I saw me being cut open only to find my baby severely damaged for my “insolence” towards my doctor and his recommendations about delivering a big baby vaginally. My initial reaction to this horrifying vision, was to tighten up, literally trying to close my cervix, vagina and legs. For a very brief moment I could feel the words “I want you to just take him!” on my lips. I think my boyfriend sensed my hesitation, whispered encouraging words in my ear, and I pushed out my 9lb 3oz baby boy in less than 5 pushes, just as I’d done with my previous other two, weighing in at 8lbs 8oz and 7lb 6oz respectively.

    I avoided an induction, but I did not avoid the anxiety and drama that enforced scheduled inductions can produce in a woman. Feelings that are completely unnecessary in many cases!

  • jillunnecesarean

    On Mom’s Tinfoil Hat, Hilary wrote awhile ago about a study that suggests shoulder dystocia might be iatrogenic (doctor caused) under certain conditions:

    “The triad of labor induction, oxytocin use, and birth weight greater than 4500 g yielded a cumulative odds ratio of 23.2 (95% CI 17.3-31.0) for shoulder dystocia.”

    For those who don’t understand odds ratios, it says that with that triad (large baby, induction and pitocin), there will be a shoulder dystocia also occurring 23 times more likely than if this triad did not exist. It seems to me that labor induction and use of pitocin actually increases the risk of a dystocia, instead of decreasing it, especially if it is likely that the baby is large.”


    Take home message: Maybe inducing big babies to get them out before they get any bigger is CAUSING the very thing (shoulder dystocia) that doctors are trying to avoid by forcing them out before they get any bigger.

  • amytuteurmd

    Most of what you have written is correct, but some very important information is missing.


    First, inductions have risen dramatically, but stillbirths have fallen dramatically as a result. According to the CDC, stillbirths have fallen 29%. That means that inductions are saving lives.


    Second, Henci Goer is quite disingenuous in her criticism of Cytotec. It is a safe and effective method of induction as long as a woman has not had a previous C-section.


    Cytotec has become something of a "bogeyman" among natural childbirth advocates. They profess horror that Cytotec increases the risk of uterine rupture in women who have had a previous C-section. Yet by far and away the most common risk factor for uterine rupture is attempted VBAC.


    That raises the question:


    If Cytotec an abomination because it increases the risk of uterine rupture, why is VBAC desirable despite the fact that it increases the risk of uterine rupture?

  • cpcwatcher

    Routine, scheduled inductions without medical indication is far too common. UNFORTUNATELY, i think lots of it comes down to $$$$$$$$

    The doctor who catches the baby is the one who gets the cash (or the doctor who sweeps in after the L&D nurse and catches the last 1/3 of the baby, as the last birth i attended went!), so doctors who have been in attendance to the woman’s whole pregnancy might actually not be on call when she goes into labor and delivers. My last doula client was a Medicaid patient, and her OB is sort of known as “the OB for Medicaid patients”. He has so many at once, because of the way he really does help to ensure women don’t have to pay extra for their hospital births, that he likes to induce 3-4 days before the due date to ensure he can be present for all of them. For the most part i think he’s doing it out of compassion for his patients, but because he’s one of the few all-Medicaid OBs in the area, the system sort of forces him to take measures like rampant induction. And he is a great OB. He really cares for his patients, and i can tell that’s the MAIN reason why he wants to be their attending OB for the birth. But it’s something to think about… our health care system and how it hurts everyone…

  • cpcwatcher

    Dr. Tuteur said:
    “If Cytotec an abomination because it increases the risk of uterine rupture, why is VBAC desirable despite the fact that it increases the risk of uterine rupture?”

    Dr. Tuteur, for me it’s not about whether or not Cytotec increases the risk of rupture more than VBAC. For me, as a reproductive justice advocate and birth doula, it’s about the woman’s choice. I think we agree that the woman should have every single perspective on both Cytotec and VBAC available to her, readily, and in plain English. After that, it’s up to her.

    Additionally, VBAC that occurs naturally is far safer than a VBAC where the labor has been induced or augmented by unnatural agents such as Pitocin or Cytotec. The body’s natural defenses allows for VBAC to work the majority of the time. It seems to me, then, that the real culprit of failed VBAC is medical intervention.

  • xenamomma

    Dr. Tuteur,

    When you say that still births have decreased by 29% so induction must be saving lives, that is really some sketchy math/science!  There is no scientific link between the decrease in stillbirths and medically unneccessary inductions.  There are many reasons why stillbirths have fallen.  It is even more irresponsible to imply that the dramatic increase in induction is in direct proportion to the decrease in stillbirth. 

    Amie does not write with the purpose of demonizing induction, only to bring light to the issue and encourage Mother’s to be fully informed.  Including to ask the question, "What happens if we wait?"

  • amytuteurmd

    "There are many reasons why stillbirths have fallen."


    Such as?


    The primary purpose of induction is to prevent stillbirth. As inductions have risen, stillbirths have fallen. In order to make an informed decision, women should be informed of these facts.

  • patrice

    Dr. Tuteur said:

    “The primary purpose of induction is to prevent stillbirth”.

    If the primary purpose of induction WAS to prevent stillbirth at one point in time in obstetrics, I would certainly argue that now there is a rampant abuses of induction.

    I was healthy, my child was healthy, there was nothing medically indicating that I needed to be induced, not even having a big baby, because I had a tried and tested pelvis for that. I’d never had a stillborn, my placenta was fully functional, my fluid level was good and I was not even close to being overdue when I was scheduled for my induction. And that is just me. I’ve talked to countless women with the same story, or similar stories. There have been women who have had inductions offered to them or mentioned for no real reason at all. It’s just put on the table if that is something she wants to do. What is rarely mentioned in these stories is the doctor also bringing up the risks vs. benefits of induction. And so informed consent was never made. Some women didn’t even know they needed to give consent for such a thing.

    I also know women who need inductions, who benefit from them. One of my best friends gave birth this past July and her induction was medically indicated, but even in that case she wasn’t given informed consent. She and I talked about the risk and benefits of induction, her benefits outweighing the risks, and the risks of not having one being higher than that of having the induction. Having said that, I do not believe that the vast majority of the women I’ve talked to or know NEEDED inductions. While I’ll admit that is a small number of people in the scheme of things, once you multiply that by the women they know, and so on and so on, what you come up with is the point I think this article was making. Yes, there are good reasons to have induction, but there are so many instances where not only is that not what the woman wanted, but nor is was there a good reason for it. And that really needs to stop.

    By the way, I know women who have made decisions to have induction based on discomfort or other personal non-medical reasons, and I support a woman’s informed choice. I think more than anything, that is what it boils down too, allowing women to make informed-choices from a risk/benefit standpoint.

  • progo35

    All I can say is that if the doctor told me to have an induction because my baby was large or whatever, I would go with what the doctor says. I am much more inclined to take Dr. Tuteur’s advice as a doctor than I am the advice of someone advising me from a reproductive choice standpoint. Yes, women should have choices, but none of the women in this story were actually forced to undergo inductions, their health was not in jeopardy because of the induction, and all of children born as a result were healthy. Now, if the doctor involved tells me, “I want to do an induction because it’s more conveinent for me,” that would be another story, but that is very rare.

    "Well behaved women seldom make history."-Laurel Thatcher Ulrich

  • equalist

    All three of my children were induced. My first two because my water broke with no contractions or signs of labor, and my youngest because two weeks before her birth I moved over an hour away from the hospital with a history of very short labors (5 hours and 3 hours from induction) and there was a very real risk of not making it to the hospital in time if I went into actual labor on my own, considering my history and that this was my third child. All three of my inductions were done with pitocin, and there were no complications during labor or delivery, aside from my second child, with whom I had a militant natural childbirth advocating doula who disrespected my wishes, and I fought against my body through the entire process as a result. Once the epidural was administered (at barely 4 cm dialated after two hours, a long stall time for all three of my labors) and I was able to relax, my daughter was born in less than half an hour (despite the doula’s claims that it could be “all day, or at least several hours” before she would arrive). There is nothing wrong with natural childbirth, or avoiding as many interventions as possible or all of them if you can (Even though I insisted on the induction when I was having no signs of labor on my own, and the pain relief during the delivery, I also insisted that I not be given an episiotomy, and postponed the breaking of my waters with my third) but each woman should make that decision on her own, and what’s right for one is not right for all.

    Equal rights, equal responsibilities.

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