From Midwifery Today, Issue 63, Autumn 2002
It’s been said that induction has reached epidemic proportions in this country, but I dispute that statement. Induction is so common that it is no longer of “epidemic” proportions; it is now “pandemic.”
Recently collected data on interventions in labor shows a “dramatic rise” in inductions during a 10-year period. Induction of labor doubled between 1987 and 1997, with the rate jumping from 9% of births to 18.4%! Meanwhile, the rate of “chemical stimulation” increased from 11% to 17.4%. Over one-third of women had their labors induced or augmented, but the researchers say this number is low and that induction of labor is frequently underreported. The data also shows, surprisingly, that midwives are inducing as often as doctors.
I’m a midwife with an innate faith in childbirth as a normal, natural function. When I hear that one-third of American women are given chemicals to start labor, I have to either conclude that women have somehow lost the ability to give birth or that we are witnessing a societal change. If women are being induced for the legitimate reasons of health and safety, then mortality and morbidity statistics should be improving. Yet the statistics are quite flat. We see little change in US statistics, except for in the category of tiny, preterm babies. An induction and augmentation rate of over 35% has not seemed to improve the health of mothers or babies. It has, however, strongly impacted the cesarean rate and—subsequently—the rate of VBAC and uterine rupture after prior cesarean section.
Induction is so common that many people are unaware of the risks. Even a “simple,” uncomplicated induction can begin an avalanche of interventions. It often starts with a cervical stretch and sweep to “ripen” the cervix, IV Pitocin, electronic fetal monitoring (EFM) and amniotomy; then, perhaps, it’s on to an intrauterine pressure catheter, amnioinfusion for unusual fetal heart tones, an epidural for the pain of Pitocin-induced contractions and malrotation or poor descent because of the epidural; then maybe a vacuum extraction or cesarean is performed for “failure to progress.” It goes on and on. The mother ends up with lifelong injury to her uterus. Her baby may be stressed and separated from the family. A normal birth may turn into a nightmare. And that’s if all goes well! If there are complications or a surgical emergency, then the nightmare really begins.