This was the headline of a front page article in the Sydney Morning herald last Saturday (26/11/11). The table accompanying the article showed Norwest Private Hospital to have one of the highest induction rates in the state (46%). The article was well written and included interviews with both representatives from the college of midwives and the college of obstetricians.
There were however a couple of major issues which were not mentioned in the article. The first is the assumption that all inductions are equal. Whilst there is agreement that induction, or the artificial commencement of labour is an intervention which has the potential to cause harm and therefore ought not to be taken lightly. There is good evidence to support the view that if circumstances are “favourable” for induction of labour ie things are ready for labour to commence, that the risks associated with induction are negligible. This is especially so in women who have had a successful vaginal delivery previously,. There is also no doubt that inducing labour when the body is not showing signs of being ready for labour is associated with a significantly increased risk of labour complications and caesarean delivery. I would argue that part of good decision making and good care is knowing when it is safe to wait and when it is safe and reasonable to induce.
The other issue which was not raised relates to the expectations of pregnant women themselves. There are many pressures which drive requests from the women for induction of labour close to or shortly after the due date. These include things like baby sitter availability for other children, concern about wellbeing of the baby in overdue pregnancy, partner’s work commitments, own work commitments! the “discomforts” (sometimes major pains!) of late pregnancy just to name a few. The number one most common reason I book inductions of labour is maternal request.
Back to the Norwest Private figures, I find it extremely reassuring to know that although our induction of labour rate is relatively high, our caesarean section rate is comparably low for a private hospital of our size and that our rate of admission of babies to intensive care is extremely low (reflects in some ways the quality of care provided in labour). In other words our inductions do not appear to be causing any increase in poor outcomes or complications. Again I would argue that the induction rate itself is no cause for alarm unless it is associated with an increase in the rate of labour complications.
I will always respect the rights of women to make informed choices about the care they receive during pregnancy and childbirth and to take an active role in the decision making process. I am sure the debate will continue…..