Edited from article by Deb Puterbaugh, Midwifery Today Sept 2022
We have a problem! Labor induction in the United States has more than tripled since 1990.
The rate of induction of labor in the US has risen from 9.6% in 1990 to 31.4% in 2021, including 41.7% of first-time births. Induction of labor (IOL) is a common obstetric intervention that stimulates the onset of labor using artificial methods. Rates of labor induction have tripled since 1990. There is substantial variation in IOL rates worldwide, which can be attributed to variability in the guidelines and lack of consensus on the clinical practice guidelines on IOL. Nowadays, in high-income countries, the proportion of neonates born following IOL is estimated to be approximately 40%. In contrast, the corresponding rates are generally lower in low- and middle-income countries. ALARM BELLS SHOULD BE GOING OFF THE CHART.
This is a CALL TO ACTION for an awareness that this is bad for humanity and birth. It is a call for prenatal classes to educate women to reclaim the nature and the physiology of birth for future generations. It is a call for labor and delivery services to reclaim their place as guardians of human reproduction.
The medical body of knowledge known as obstetrics can be lifesaving, but it is not midwifery. A clear understanding of the difference is necessary before we can intelligently discuss birth and the effects of any medical obstetrical intervention, including induction, on human reproduction with any integrity.
Midwives were mentioned as far back as the Egyptian Papyrus Kahun. A midwife knows that human reproduction is biological and instinctual. Midwives demonstrate a deep respect for and understanding of the natural process of creating new humans, as opposed to the new, Western, medical/surgical profession of obstetrics that sees human reproduction as mechanical and profitable. Obstetrics is a less than 100-year-old “medical specialty” that has shown little respect for the natural biology of human reproduction. Its trade association, the American College of Obstetrics & Gynecology (ACOG), founded in 1951, is the self-proclaimed authority on maternal/child health. ACOG has not taken the time to scientifically observed the phenomenon of physiological birth, but rather has approached human reproduction and maternal/child health as something to dominate and control, as well as to profit from.
The etymology of midwife, which literally means “with women,” defines a mindset of partnership and respect. The etymology of obstetrician is “to stand before,” and defines a mindset of distance, superiority, knowing, interference, and control.
Statistics show that in countries with continuous midwifery care, women and babies do better than in countries with obstetricians in control. Sweden has had a history of uninterrupted midwifery care for all women. In Sweden, the entire birth process, including prenatal and postnatal care, is managed by midwives, rather than obstetricians. The only exceptions are mothers with certain pre-existing health conditions or with complications that arise, in which case the mother will be referred to a hospital doctor. Sweden is one of the safest places in the world to give birth.
Contrast this with the US, which has a history of oppressing midwifery and still, to this day, cannot seem to understand the difference between obstetrical care and midwifery care. Among 11 developed countries, the United States has the highest maternal mortality rate and a relative undersupply of maternity care providers, and is the only country not to guarantee access to provider home visits or paid parental leave in the postpartum period. Compared with any other wealthy nation, the US also spends the highest percentage of its gross domestic product on health care (Commonwealth Fund 2020).
To address the issue of induction it is necessary to grasp the above concept: that of efficiency and time being central to obstetrical understanding of the birth process. When obstetrics first began to try to understand human parturition it set about to categorize, label, and measure all aspects of the machine it wanted to control. Obstetricians have made up number systems, and created curves and graphs to explain a process it could never experience or fully understand. It pronounced stages, averages, and parameters to control the process. To this day this absurd obsession with numbers, time, and control shapes most of the obstetrical understanding of human reproduction. It is this “Obstetrical Myth” that is taught in universities to obstetricians, nurses, and, now, midwives. Most of it is not scientific at all, and much of it is not even evidence-based or factual (Davis-Floyd 2003).
The first silly, made-up story a pregnant woman must deal with is that of a due date. Lamaze classes must burst this myth. Most people know how babies are made and we understand that, for the most part—excluding IVF—it is an organic, natural process. What a lot of people don’t know is that a sperm and an egg have lives of their own. A very private and uncontrollable journey that is truly a miracle of nature—conception—is not measurable. The truth is that ejaculated sperm can remain viable for several days within the female reproductive tract. And women can potentially ovulate two or even three times a month. Fertilization is possible as long as the sperm remain alive—up to seven days. Only 4% of babies are born on their due date. Eighty percent arrive between 2 weeks before and 2 weeks after this date. So due dates are really due periods, with the EDD (estimated due date) as a middle point within a 4 week period, NOT an end point, after which, things are pathological.
Furthermore, ultrasound gestational dating is not an exact science. An ultrasound at 20 weeks’ gestation is accurate only to ±1–2 weeks’ gestational age. Combined with the fact that developmental variability exists during fetal maturation, the task of accurate gestational age prediction is even more challenging. Perhaps it’s time we asked ourselves some questions. Like, why all the fuss about due dates? Won’t babies be born when they are ready? What actually triggers labor? In 2004, researchers at UT Southwestern Medical Center at Dallas discovered that the baby actually has something to say about when she will be born. A protein called surfactant, released from the lungs of a developing fetus, initiates a cascade of chemical events leading to the initiation of labor (ScienceDaily). This should lead us naturally to question why anyone would want to “induce” a woman to go into labor. The sad fact is that it happens all the time.
Induction is an obstetrical medical intervention that clearly needs to be re-evaluated in light of the problems. This intervention has now been allowed to dominate women’s births. The obstetrical myth that this intervention helps EVERYONE must be not be allowed. Birth classes can help teach the truth about low-risk pregnancy and alternatives to unnecessary interventions.