TUESDAY, Aug. 20, 2002 (HealthDayNews) -- Babies used to be born when they were good and ready to come out.
That's not necessarily the case anymore.
The past decade has seen a dramatic rise in the number of induced births in the United States -- from 9 percent in 1989 to 19 percent in 1998, says a new study.
Researchers aren't exactly sure what to make of the trend, but they are concerned. A prime reason for their worry: Many of the babies that were induced were pre-term, meaning labor was induced before the 37th week of pregnancy.
The rate of babies induced before the 37th week of pregnancy doubled, from 6.7 percent of inductions in 1989 to 13.4 percent 10 years later.
"We're very concerned," says Marian MacDorman, the lead author of the study and a statistician with the National Center for Health Statistics. "The assumption is often made [that] these are spontaneous pre-term births, but medical intervention is also playing a major role in pushing up this pre-term birth rate."
Babies who are born prematurely often require longer hospital stays and are prone to illnesses and complications, MacDorman says.
Researchers aren't exactly sure why the number of induced labors is going up.
Some women are requesting, and even demanding, inductions to fit their busy schedules. Some women want to make sure their husband or mother is around for the birth, and others want to make sure their own doctor is available for the delivery, says Dr. Richard Henderson, an obstetrician-gynecologist at St. Francis Hospital in Wilmington, Del.
"We call these 'convenience' inductions," Henderson says. "The patients are uncomfortable at 38 or 39 weeks. It's the summertime. It's 100 degrees out. Her feet are swelling or her doctor may be going on vacation. These are inductions for reasons other than medical."
The problem is that induced labor can increase the risk of cesarean section, especially if the woman's body isn't quite ready to go into labor. For that reason, Henderson says, he tries to persuade women to wait.
C-sections, while very safe, have added risks including infection, injury to the baby and a longer recuperation time, he adds.
"I really try to counsel the patient that if it's not medically or obstetrically indicated, there is no real reason to do it," he says. "But pregnant women can be very persuasive."
Dr. F. Ralph Dauterive, chief of obstetrics at the Ochsner Clinic Foundation in Baton Rouge, says he is also concerned by the uptick in induced labors. Very little research has been done into whether or not induced labor is truly safe, he says.
"The elective induction rate is rising based on no good data," Dauterive says. "Women are being induced because they want to pick their delivery rate. Doctors want to deliver during the day and during the week. It's all about convenience."
He adds: "My question is: 'Why are we allowing elective inductions to take place when it could be dangerous and there is not good data to confirm that it's safe?'"
As for pre-term inductions, Henderson says he knows no doctor who would induce for convenience before 37 weeks.
"Pre-term inductions are always done for medical reasons, either because the baby isn't growing and would do better on the outside, or because of risk to the mother's health," he says.
In this latest study, which appears in the August issue of Pediatric and Perinatal Epidemiology, researchers analyzed birth certificate data for all U.S. births from 1989 to 1998. According to the study, only about half the babies induced pre-term had a medical reason listed on the birth certificate for the induction.
However, MacDorman says that doesn't necessarily mean babies are being induced prematurely so the doctor can make his tee time. It's probably that some birth certificates weren't filled out completely, and medical information was left out, she adds.
And she suspects most pre-term inductions do have some medical basis. The mother may be having difficulties with the pregnancy, such as high blood pressure or diabetes. In the past, doctors may have been more likely to wait. Now, they may opt for induction.
"There are a lot of situations in which the pregnancy is not ideal," MacDorman says. "The mother could be having problems, and then the clinician has to make a judgment call whether to induce or to hang on for another week.
"I think the decision-making has changed a little bit. Doctors have gotten a little more comfortable with induction, and maybe less worried about pre-term baby mortality," she says.
One reason for that is because medical advances have improved the chances that premature babies will have no lingering medical problems.
"Maybe they feel on balance it's better to do the induction," MacDorman says. "But pre-term birth is generally something you want to prevent unless it's really life-threatening for the mother."
Another issue is that race and education seem to be playing a role. White, college-educated women who had intensive prenatal care had higher induction rates than other groups.
"To me, that's showing a bias in how the obstetricians are practicing," MacDorman says.
What To Do
Read about the pros and cons of induced labor at KeepKidsHealthy.com or AmericanBaby.com.
