Wednesday, September 16, 2009
Now We're Getting Somewhere!
To all the friends and collegues who've signed on and started the discussion, I want to personally thank you! I've heard some very good personal stories of their own birth experiences, as well as from the maternity nurses who are in the trenches. In my research, I have found that ACOG recently changed their views on induction, and revised their induction guidelines from no earlier than 38 weeks gestation to no earlier than 39 weeks gestation. I think this is a giant leap in the right direction! My question is this: Are the pregnant women and their families pushing the issue by requesting the induction? Or are they simply just doing what is recommended by their provider. I wonder if they were ever given any education on the matter? Food for thought...
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Kristin, you have really chosen a great topic...very timely and controversial. I worked collaboratively with many physicians, nurses, and managers at a local tertiary care center to develop induction guidelines nearly 2 years ago. We reviewed the same issues that you bring up here...what constitutes "medical necessity" and what is truly "elective". We also developed an informed consent form that would be provided to patients in the office and must be signed before pitocin could be started. This meant that the providers were actually the ones obtaining the consent, how it is truly meant to be. The consent listed out newborn and maternal risks for induction....it was a great end product that works well to this day!
ReplyDeleteI haven't seen anyone tackle the idea of term elective inductions in primigravidas vs. multigravid women. Is it not okay to induce a G4P3 at 39+ wks who is 4 cm in the office? Has a history of quick labors or is GBS+?
I think it's a little of both. Sometimes it's the provider pushing to have all "their" deliveries on their call day, sometimes it's the patients demanding them. I think mostly the patients just do what they're told. It's one way to know they will get the provider they want. It's also easier to schedule childcare, maternity leave, etc.
ReplyDeleteI work with one group that does not give in to their patients, and only schedules medically necessary inductions, or for really good social reasons. Dad's home from Iraq for two days, that kind of thing. If they do schedule an induction for post-dates, then their patients are truly post-dates. 42 weeks, not 40 weeks, or 40 weeks and one day.
We have other groups, though, that schedule most of their patients so they will deliver on certain days and times. Yes, truly, times! As in, on their lunch break, or after office hours.
What a great topic Kristin! I think most of the inductions we do are elective or at the suggestion of the provider. That being said, I've not seen many inductions less than 39 weeks. As a patient advocate, I do find it disturbing when you ask a patient why they are being induced and they have no idea. I think women just trust what their doctor tells them. There is a lot of education that needs to happen to make sure families are making informed decisions.
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