Minnesota To Curb Elective Induction Before 39 Weeks


In an effort to curb what is seen by many in the medical establishment as a dangerous and unnecessary practice, the state of Minnesota is proposing requiring doctors to fill out additional paperwork if they intend to induce labor in a pregnant woman before 39 weeks gestation for “convenience.”

Via the Minneapolis Star Tribune:

Minnesota might become the first state in the nation to create a policy against a common practice in obstetrics: inducing childbirth early just for the convenience of doctors or mothers.

Mindful of research showing health problems with babies delivered early, the state Department of Human Services has proposed that hospitals create plans by 2012 for reducing elective inductions prior to 39 weeks gestation. The penalty for those without plans? Fill out onerous paperwork for every state-funded delivery.

The policy would sync with a campaign by the March of Dimes to encourage women to carry their pregnancies the full 40 weeks whenever possible.

“Just because we have the tools [to induce labor] doesn’t mean we should be using them,” said Marianne Keuhn of the Minnesota chapter of March of Dimes, an advocacy group that promotes healthy babies and pregnancies.

While 37 weeks gestation is considered full term, research has shown higher rates of respiratory problems, longer hospital stays and intensive care for babies born before 39 weeks. Induced labor before 39 weeks also increases the rate of emergency C-section deliveries.

According to the article, one in five pregnancies in Minnesota are induced, although the data do not make clear what share of inductions are done for medical reasons. It provides assorted percentages of pre-39 week induction in multiple hospitals throughout the state, but again does not break those numbers down by elective versus medically- indicated inductions.  One hospital in the state shows that nearly 80 percent of their births were induced, with nearly half of those inductions occurring before 39 weeks, but the hospital says that numbers are the result of a malfunction in their new reporting equipment.

So, how wide of an issue is early elective induction?  It’s very difficult to tell based on what information is available.  Many hospitals across the state, such as mine, already have policies in place that prohibit inductions or c-sections before 39 weeks.  And the excuses that the author says women give for requesting the procedure, such as wanting to avoid birth on a given holiday, living too far from the hospital, or having family in town to care for other children can all be resolved without moving ahead of 39 weeks.  As for the excuse that the mother didn’t want her child to have a particular zodiac sign, well, that sounds suspiciously similar to the anti-choice myth of the myriad of women who decide at 37 weeks pregnant that they want an abortion so they can go to a concert.

I spend a great deal of time on message boards with women who are at roughly the same stage of pregnancy I am in.  Of those that have discussed early induction, the only reason I have ever heard for any of them to be considering this step it is that their doctors are going on vacation, especially a problem for those of us due during the holiday period from Thanksgiving to New Years.  Although we joke about wanting to get these babies out as soon as possible, or making sure they arrive in time for our tax credits, or that we don’t want to spend Christmas Day in Labor and Delivery, what we really want is our healthy babies.

Is the early elective induction occurring in the crisis level amounts that the article seem to be promoting?  My guess is no, but the additional paperwork burden can still be useful to address and dissuade those doctors who are pushing for their patients to undergo them, in a way that doesn’t punish the women who are involved.  If that can potentially lead to healthier babies, it could be a beneficial policy for many.

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  • prochoicekatie

    “…but the additional paperwork burden can still be useful to address and dissuade those doctors who are pushing for their patients to undergo them, in a way that doesn’t punish the women who are involved.”

     

    The thing is, the paperwork is required whether or not the induction is medically indicated. The flip side of this coin is that  doctors who want to avoid additional paperwork may ignore a medical indication instead of proceeding with the induction.

    I really do not feel that the courts or legislature need to continue to ‘make or dissuade’ the decisions of women and their doctors. Weren’t we just talking about trusting women?

    I think this particular policy still reeks of the paternalism of so many other policies designed to tell women what to do with their pregnant bodies.

    The incentive to waiting for both mom and doctor? A healthy baby, a (likely) less complicated delivery, and the greater likelihood that a woman will not need unnecessary medication or surgical intervention. Those seem like great incentives for both parties.

    Doctors fill out lots of paperwork already. The information in those forms is likely already being collected. This seems to be a way of interfering with the choices made by a woman and her doctor, and I’m not sure I’m okay with it.

  • mechashiva

    Yeah, I think that any court battle is a waste of time and money if it concludes more paperwork is a solution to any problem, simply because the paperwork is more inconvenient.

     

    If you want to dissuade a behavior, increasing paper-pushing aint gonna cut it. If it isn’t so bad that you want to introduce real punishments, then it should be something the medical community handles on its own.