The Madeleine Brand Show for February 17, 2012

Scheduling baby's birthday

Joe Raedle/Getty Images

A woman looks at her ultrasound.

Last week, the Obama administration announced a national campaign aimed at reducing the number of early scheduled childbirths. These are deliveries scheduled before 39 weeks of pregnancy, for non-medical reasons.

Reporter Lauren Whaley brings us more on the culture and risks of childbirth by appointment.

Corrie Carroll’s husband travels a lot for work. So, when it came time for the birth of their daughter, the Pasadena couple made an appointment. “He arrived home from Europe on a Wednesday night and we drove to the hospital at 6 a.m. on Thursday morning. I checked in. I put my hospital gown on. They gave me Pitocin. About an hour later, they gave me an epidural and eight hours later I had a baby. And it was perfect,” Carroll recalled.

She’s not alone in wanting to control when the baby arrives. Doctors are inducing their patients’ labor without a medical reason now more than ever.

Dr. David Lagrew is a maternal fetal medicine specialist at MemorialCare Health System in Orange County. “If you really look at inductions and say, what percentage of inductions we do today fall into the elective category, it’s the vast majority of them,” Lagrew says.

These scheduled labor inductions have been going up, mostly for the convenience of the doctor and mother. Pregnant women are simply sick of being pregnant, or they want a certain delivery date. Doctors want to deliver their own patients, so they suggest induction for a day that fits their schedule, “If I can deliver everybody from 8 to 5 Monday through Friday, that’s a better lifestyle than being up all night,” Lagrew says.

And data from a recent Stanford University study show that the rates of scheduled labor induction vary widely in California. Women who live in Pasadena, Burbank and Glendale are twice as likely as other moms in the state to have their labors induced without a medical reason. That’s over six times the rates for women in Napa and Red Bluff.

Why the disparity? The study’s author suspects that habits catch on. Doctors in a certain area get used to the convenience of inducing their patients. Or, neighbors tell each other about their scheduled births. These practices have some people concerned.

Tracy Hartley is a birth doula and has coached more than 400 women through childbirth, and she thinks induction is a huge issue. She says moms are starting to tell their doctors, “'Um, I don’t want to be induced thank you very much.' I tell my clients, 'Doctor’s not going to come to your house and induce you.' So If the doctor says, come in on Thursday morning for an induction, you say, 'I’m not ready, my baby’s not ready,' and the doctors have to go along with that as long as the baby is safe.”

Hartley says some women don’t realize that induction of labor means chemically starting contractions with synthetic hormones, usually synthetic Oxytocin or Pitocin, administered through an IV. Induction gets women into labor faster than Mother Nature does. If you’re a first-time mom, induction doubles your chances of getting a Cesarean Section.

Dr. Aaron Coughey is a Maternal-fetal medicine specialist and health economist at Oregon Health and Science University. He points out that the more things doctors do to a laboring woman, the longer the woman has to stay at the hospital. And the longer the stay, the more money it costs. “A lot of labor is one on one nursing and at most, two on one ... and that’s around the clock. So, you’re paying somewhat continuously around the clock, and that adds up pretty quickly,” Coughey says.

As for the babies, they face the biggest health risks when their mothers are induced before 39 weeks of pregnancy, “36 week-ers don’t do as well as 37. 37 doesn’t do as well as 38. And even 38 on average doesn’t do quite as well as 39,” Coughey said. Babies born early have a harder time breathing and eating, and end up in intensive care more often. “I do think we will see the vast majority of hospitals put a stop to elective deliveries less than 39 weeks,” David Lagrew says.

It's a trend that started even before the federal government made its appeal last week. For an induction after 39 weeks, there’s still a greater risk of c-section for first-time mothers, but doctors are much less worried about the baby’s health.

Remember Pasadena mom Corrie Carroll? She’s had two induced labors. “I support induced births. I think 39 weeks was a good time to have my baby,” Corrie says. “It’s really hard at the very end to wait for your baby and to wait for labor. But, if my doctor said it was OK, then ... she never once said that there was a chance that the baby wasn’t ready. And they were ready! Right? Yeah!”

They were ready. But, some babies born by induction are not. So, doctors and mothers are facing more pressure to wait until at least 39 weeks if they want to pick the baby’s birthday.

This story was produced with the California HealthCare Foundation Center for Health Reporting


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