Scheduled Delivery

Should you choose your baby's birth date? Here's the lowdown on this growing trend.

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It’s common knowledge within the medical community that in response to their busy lives, many celebrities, sports stars, high-powered executives and their partners quietly schedule their babies’ births. Why? Often so that mother and father can ensure they will be together on the big day. The trend to control when and where a woman gives birth extends beyond the rich and famous as more pregnant women across the country choose their dates for labor inductions and even Cesarean sections. Women make this decision for many reasons: fear of the unknown, school-vacation schedules of older children and work considerations being among them. But while scheduling birth might sound convenient for those who want to have their babies at a certain time or comforting for those who are terrified of labor, scheduling an induction or a first-time C-section isn’t without risk—or debate. If a scheduled birth is an option you are considering, you should understand the hazards involved in order to determine whether the procedure can provide the peace of mind you’re seeking.

Inducing labor> Inducing labor with drugs is one way to help ensure that childbirth occurs in a specific 24- to 48-hour period. In 2000, nearly 20 percent of babies were delivered after labor was induced—up significantly from 8 percent in 1989, according to the American College of Obstetricians and Gynecologists (ACOG). Does this increase indicate that inductions are always safe? No. “ACOG is four-square against inducing labor just because you want the baby to be a Sagittarius,” says Michael F. Greene, M.D., director of maternal-fetal medicine at Massachusetts General Hospital in Boston. “It should be for medical reasons.” Inductions should only be done when the risk of continuing the pregnancy exceeds the risk of induction of labor, according to ACOG; such risks include high blood pressure or a pregnancy two weeks past due. Still, doctors do induce women who don’t fit into these categories. Anne Boris of Chicago accepted her doctor’s offer to induce her because she was bloated and uncomfortable and feared that her water would break while she was at work. “I was opposed to the chaos of labor in public,” she says. “[The induction] gave me a sense of control and security.” While Boris experienced no major complications, women who are induced should be aware that they are increasing their chances of a C-section by 50 percent, according to Greene. “If a woman and her physician decide to induce, they need to accept that there might be a more difficult labor that may result in a C-section,” he says. “And if a woman is planning a vaginal birth after Cesarean, there is an increased risk of uterine rupture after induction.” Inductions aren’t always successful. True, doctors can see if a woman’s cervix is “inducible,” or softened and positioned correctly, but that doesn’t guarantee a smooth labor. Hormones such as oxytocin are released when a woman goes into labor naturally. But just because a doctor can administer Pitocin, the synthetic version of oxytocin, does not mean that labor will necessarily begin or progress easily. In fact, if Pitocin is given too aggressively, labor can be more unpleasant, with contractions that are too forceful and frequent. Robert Katz, M.D., of Cedars-Sinai Medical Center in Los Angeles, has performed many inductions. He says that one patient, whose husband is a well-known basketball player, was induced to make sure the spouse could be there for the delivery. All went smoothly. “I have no problem inducing under safe circumstances,” Katz says, “when the cervix is ready and it’s past 39 weeks.”

Planned C-section … a better option?> Surprisingly, some doctors say that women who are determined to schedule labor are better off planning C-sections instead of inductions. This is because a scheduled Cesarean often results in less wear and tear on a woman’s body than a long, induced labor that ends with an emergency C-section. Also, emergency C-sections are more rushed than planned ones, increasing the possibility of complications. While ACOG is firmly against performing C-sections for nonmedical reasons, there are doctors who typically record the procedure as medically necessary. In fact, Cesarean delivery rates have increased for five consecutive years, accounting for nearly 24.4 percent of all births in 2001, according to the National Center for Health Statistics. One doctor in her final year of residency at a hospital in Dallas, who spoke on condition of anonymity, says she may have her first child by elective C-section and that many of her female colleagues feel the same way. She is considering it after seeing a number of unsuccessful inductions and reading about the urinary incontinence that sometimes follows a vaginal delivery. She adds that while a Cesarean section is major abdominal surgery, doctors no longer cut through muscle, which makes it easier to heal from the procedure than in the past. Still, a Cesarean delivery can take weeks and sometimes months of healing and brings an increased risk of infection and blood loss. It’s not a decision to be made lightly. In a perfect world, we’d all be able to order the exact date of our labor and the perfect delivery; it would certainly make for a more organized birth. But our world isn’t that neat, and the birth of a child is miraculous and full of surprises. In our efforts to control labor, it’s important for a woman, her partner and doctors to examine the risks carefully and determine whether they are really worth taking.

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