Avoiding unnecessary inductions and c-sections: "Every week counts"

I was going to title this post "Sick of being pregnant? So what?!" but thought maybe that would come off as a little harsh.

I've written about this several times, as have a lot of others. Unfortunately, I'm not really sure who's listening (one woman decided that since the Huffington Post, whose link I've included below, was not an unbiased source of news, that perhaps the article wasn't true). I've been posting links ad nauseam to the March of Dimes website for months about Why the Last Weeks of Pregnancy Count, in hopes that someone out there is actually reading it. And this month, they and ACOG have teamed up in hopes of decreasing unnecessarily early births because of elective, non-medical inductions and cesareans.

Obviously there are some exceptions, as this article from the Huffington Post noted. While I was glad to see this subject go mainstream, I did have a problem with this paragraph:

“If a baby needs to be born for a medical reason, that baby should be born,” said Dr. George Macones, an OBGYN at Washington University’s School of Medicine in St. Louis. “But when I was practicing in Philadelphia, patients put pressure to deliver early for what I call ‘social purposes.’”

While I'm certainly not denying that mothers do pressure doctors to do inductions, let's not lay the onus of blame completely on the mother. Doctors are often notorious for scheduling for convenience, and so many women can testify to that in their birth stories. It's also not uncommon for a diagnosis of "failure to progress" to come hours before a physician has an important upcoming event to attend. And sadly, we hear of plenty of doctors who pressure moms into cesareans before their shift runs out at 5 p.m.

As far as 'medical reasons,' this is often another gray area. True medical problems are one thing, but we're also finding more and more that doctors are using questionable medical diagnoses - like big baby and low fluid, most frequently - to assess whether or not the baby should be born. In the case of a big baby, there is no definitive answer to that question, except weighing that child right after birth. Some estimates are more accurate than others, and some are way off. In this case, you need to ask yourself, do I want to risk having major surgery - for this baby and potentially all my children - if my child happens to weigh substantially less than estimated?

It probably sounds like I'm anti-physician. Not really. But I wish people who think that doctors are incapable of doing these things would pull their heads out of their butts for a moment and take a look around.

As far as the Every Week Counts campaign, I'm hoping it gains some serious traction. I am not completely sure what the best answer is - but I wish we'd see some disciplinary action on the part of hospitals and medical boards for those who do like to practice "9-5 obstetrics," or have a higher-than-usual rate of cesareans. Many are coming down on the WHO's recommendation that the optimal c-section rate be around 15 percent, because they consider it an outdated (circa 1985) standard and acknowledge that the ideal c-section rate is a figure no one is really sure of. While that may be true, I think we can argue that this is far from optimal.

I've blogged before about the myth of the emergency cesarean, and have come to realize that words like "medically necessary" are relative terms. When you start questioning what is truly necessary, there are those who quickly become defensive, and assume that you're trying to say you know more than their doctor. No one likes the feeling of being pinned into the corner about their choices, or to essentially be told that perhaps they had choices they didn't even know about. I remember one particularly heated exchange on a pregnancy forum of a mother asking for induction techniques because her baby was 35 weeks gestation and she didn't "want a 9-pound baby." Why, dear God, why?! 

When it comes to laying blame, it probably fits squarely in both corners, as the above quote suggests. There are no shortage of women who want it their way, for a number of reasons - that much is true. HufPo user Trillian4210 writes:

My second baby's tentative due date was 10/10/10. My OB/GYN laughingly told me he hoped I didn't go into labor that day because he was BOOKED SOLID with scheduled c-sections of women who had no medical reason for it but that they wanted that birthday for their kid. That's not a birthday, that's a vanity story. 

What I want to know is, what is this physician doing about it? Are you informing your patients the dangers and giving them a realistic outlook of what could happen? They complain so much about mothers demanding it, when really, you're just facilitating and enabling it to happen by not informing or counseling your patients adequately to stop this from happening. This would be a perfect opportunity to go over with your patients why it's unsafe, and stop the practice altogether, not give in to their whimsical demands.

If a mother's excuse of "I want my baby's birthday to be 10/10/10!" sounds frivolous, then a doctor saying, "Your baby might get too big and then die!" should be code speak for "I have vacation to the Bahamas coming up, and there is no way I'm waiting around for this baby to be born!"

And speaking of the etched in stone due date, those people who like to criticize women for wanting to deliver their babies early are also throwing stones at women who decide to go post-dates and let the baby pick its own day. You just can't win.

For generations we have had instilled in us the idea that every "large" baby will be difficult to birth, that every baby born past 40 weeks "will die," or that because the baby has reached that magic benchmark of 37 weeks, that "it's ready!," like some kind of turkey pop-up timer.

So while it sounds great to blame the mother for going Princess Renegade and wanting everything done according to her plans, the medical community has no one to blame but itself.