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In early June of this year, a Northern California mother-to-be faced a fiendish dilemma. Mindful that the Bible's Book of Revelation described 666 as the mark of the devil, she arranged to have her labor induced before June 6, lest her son be doomed to spend a lifetime responding "6-6-06" every time anyone asked him his birth date.
And for those who might roll their eyes and say "only in California," consider this: Earlier in the year, a Pittsburgh Steelers fan asked that her labor be induced to make sure she'd be able to watch the Super Bowl.
These anecdotes tell a larger story: the dramatic increase in induced labors in the United States. In 2003 (the most recent year for which we have national statistics), the incidence was 20.6 percent--more than double the 1990 rate. The increase is due, at least in part, to elective--non-medical--requests for induction, a procedure that's controversial even though the opportunity to choose when to give birth has practical implications beyond the oddball examples offered above. Mothers with young children at home, single moms hoping to arrange for support from visiting family members, women who live far from the hospital where they plan to give birth, working mothers with complicated schedules--all may benefit from a scheduled birth. But if performed too early, elective inductions are also linked to unplanned Cesarean sections or even the delivery of "near-term" infants with medical problems.
Why inductions are increasing
There are two primary reasons for the rising induction rate, says Robert O. Atlas, M.D., chairman of the department of obstetrics and gynecology at Mercy Medical Center in Baltimore. "One is patient desire--when a woman doesn't want to go past her due date," he states. "This convenience factor applies to physicians as well," he adds. "As medical practices get larger, it is understandable when a woman wants to arrange for her delivery to be overseen by the physician she has come to know during her pregnancy, and not by a doctor who happens to be on call. And doctors themselves are often eager to be present at the birth after caring for a woman throughout her pregnancy."
The second major cause of induction is medical necessity, fueled largely by increasing obesity rates among pregnant women and the growing number of "older" mothers. Both groups are at greater risk for nonelective induction due to causes that include:
• premature rupture of the membranes (aka the "water breaking")
• preeclampsia (a potentially dangerous high blood pressure condition that requires the immediate delivery of the baby)
• an infection inside the uterus
• placental abruption (separation of the placenta from the abdominal wall)
• diabetes or gestational diabetes, both of which are linked to large babies
• an abnormal fetal heart-rate pattern
• a postdate pregnancy (being one to two weeks past your due date)
• a pregnancy with multiples