Episode Transcript
Dr. Miller: When should your birth be induced? We're going to talk about that next on Scope Radio.
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Dr. Miller: Hi, I'm here with Howard Sharp, he is a professor of obstetrics and genecology at the University of Utah. Howard, what does it mean when a woman is induced?
Howard: We're talking about labor induction. That would be starting a patient into labor artificially. Most women will eventually go into labor, in fact if you wait long enough, over 90% are just to go on their own. But in the last several decades we have gotten into a habit of starting patients. Sometimes we start them electively and sometimes we start them because it's indicated, there's a problem, maybe there's high blood pressure or preeclampsia.
Dr. Miller: So, one would be to start to do the induction because of a health reason or to prevent a medical outcome.
Howard: Yes. That will be called a medically indicated induction. But there are a lot of elective inductions that have gone on.
Dr. Miller: Are there more elective or medical inductions now in this country?
Howard: That's a good question. It probably varies from site to site. We don't have as many elective inductions here at The University of Utah, but we do do them and we do them very carefully with a lot of counseling.
Dr. Miller: I think one of the concerns you may have had was that there is perhaps more inductions than may be there need to be?
Howard: I think so. It's interesting if you look at the... for example the C-Section rate back in the '60s, it was about 5% of women were getting C-Sections. Last year it was about 33%. So, something happened on the way to the 2000s. I think maybe there is a little bit of medic-legal worry, certainly inductions became a little but more popular, we had access to Oxytocin.
Dr. Miller: That's one of the hormones that induces the labor.
Howard: Exactly.
Dr. Miller: Starts labor.
Howard: A lot of things have kind of changed plus babies are getting bigger. Sometimes baby's just a little bit bigger than the pelvis. But I think that a lot of the reasons for the increased caesarean section rate is unnecessary. That's what we're really trying to focus on getting that lower.
Dr. Miller: Is it fair for a woman to say that she doesn't want to be electively induced? Is that part of the conversation?
Howard: Yes. In fact ideally, I think most of us would agree that if a woman can go in labor on her own that is ideal and that is really what we prefer.
Dr. Miller: Why is there disagreement in the medical community perhaps about this issue of elective induction? It doesn't sound like there's much of a disagreement about induction to prevent illness or medical complications, but it sounds like there may be some disagreements over elective inductions.
Howard: Yes, there is some disagreement. I think in terms of elective inductions there are some issues and that is, there is a convenience factor that it's sometimes more convenient for the physicians, sometimes it's more convenient for the patients, their families. And so we kind of have to weigh that against the risk of having a caesarean delivery.
I think most people, if you thought your risk of having a caesarean delivery was higher because you are doing an elective induction, most people would say, "Well okay, hold off a little bit." Having said that, it doesn't mean that all elective inductions are bad. If you have an appropriate patient there really isn't much of an increased caesarean delivery rate.
Dr. Miller: If a woman has a failed induction, is that a possibility?
Howard: Yes.
Dr. Miller: How often does that happen, where you're induced but yet you don't end with a full term labor?
Howard: That is more common in a first time mom. The first time around, we really encourage patients not to be induced until it becomes medically indicated. That would be if there was a medical problem or if they had reached a point in their gestational age, whether that's 41, 42 weeks there is going to be a higher risk of still birth. Or at some point if the percentage is not working as well, there is a little bit higher risk of getting a caesarean delivery as you wait too long.
Dr. Miller: It sounds like medical inductions need to listen to the advice of your obstetrician and elective inductions certainly a more of a problem in first time moms, probably to be avoided electively. In general, discuss the use of elective inductions in second term or more term labors with your physician.
Howard: I think it really does require a conversation. For example if it's their second or third baby and they've had a very favorable vaginal birth with their first or second and their cervix is ready by that, we actually have scores that kind of grade how ready the cervix is. As long as they're at least 39 weeks, that is a reasonable thing to discuss. One of the problems has been inducing before the baby is ready. We get in a little bit of trouble here in the United States doing elective inductions before 39 weeks and babies ended up in the newborn intensive care unit which is a terrible outcome. A lot of things to consider and it's just worth having a discussion.
Dr. Miller: Do you think that discussions should occur early during the visits to the obstetrician's office well before time of delivery?
Howard: I do. I think once you kind of get close to delivery, some people are a little tired of pregnancy. I'm a guy, so obvious I've never done this but
Dr. Miller: I think as you look, you are. I get that.
Howard:
but I can only imagine it's uncomfortable. If someone is kind of expecting to be induced or if that's what they've had and then you're telling them otherwise, that's a little bit tough to take.
Dr. Miller: In your practice or your colleagues practice, do you generally bring this up from your standpoint in your discussion with your patients early on? You generally are sort of not looking to do elective inductions if possible.
Howard: Right. We usually try to bring it up at least before during the early third trimester.
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