REPRODUCTIVE JUSTICE

MEDICALIZATION IN MATERNAL HEALTHCARE

**NOTE**

Medical advancements have saved the lives of women and babies at risk for injury or death during pregnancy and birth.  This site is not about the doctors who properly use interventions to save lives; it is about those who use them unethically for profit or convenience.   Improperly used interventions have led to harm and death of women and babies and obstetrics  is the only field in which mortality rates are rising and non-medically needed interventions such as c-sections are related to 66% of maternal deaths. 

**NOTE**  This site is designed to share valid evidence for those working to change the maternal healthcare system who do not have access to databases of peered research. 

Chronological order allows users to find new data.  It also begs the question of why, when we have known for decades that such practices are harmful, do they not only continue to be used but are increasingly used.

INDUCTION OF LABOR

WHAT DOES THE LITERATURE SAY?

2024

American Academy of Family Physicians (2024). Don't Promote Induction or Augmentation of Labor Without a Medical Indication: Spontaneous Labor is Safest for Woman and Infant...  Accessed https://www.aafp.org/pubs/afp/collections/choosing-wisely/307.html

• Researchers have demonstrated that induction of labor for any reason increases the risk for a number of complications for women and infants. Induced labor results in more postpartum hemorrhage than spontaneous labor, which increases the risk for blood transfusion, hysterectomy, placenta implantation abnormalities in future pregnancies, a longer hospital stay, and more hospital readmissions. Induction of labor is also associated with a significantly higher risk of cesarean birth. For infants, a number of negative health effects are associated with induction, including increased fetal stress and respiratory illness.

Romm, A. (2024). The Induction Pressure Cooker.  Accessed https://avivaromm.com/labor-induction-low-natural-approaches-midwife-md/

• The sad reality is that conventional medical practices are not always based on the best available medical and scientific evidence, or the best interests of the mother. They are heavily influenced by doctors’ fears of getting sued, data that is skewed by the interests of professional societies, insurance reimbursers, hospital risk assessment teams, and even medical journal articles that have been written by or paid for by medical device and pharmaceutical companies.

University of Colorado Obstetrics and Gynocology. (2024).  Accessed https://eastdenver.coloradowomenshealth.com/pregnancy/labor-delivery-giving-birth/inducing-labor

• More recently there has been an increase in mothers and couples who want to induce labor for nonmedical reasons. ACOG very clearly recommends that elective inductions of labor should never occur before 39 weeks of gestation (pregnancy). Unnecessarily inducing labor, especially early, can increase health risks for both mother and baby, plus can increase medical costs.

2023

Bengtsson, F., Ekeus, C., Hagelroght, A. and Ahlsson, F. (2023). Neonatal Outcomes of Elective Induction in Low-Risk Term Pregnancies.  Accessed https://www.nature.com/articles/s41598-023-42413-6

• The present study showed that elective IOL has increased from 1999 to 2017 and that electively induced labors are associated with negative infant outcomes compared to labors with a spontaneous labor onset. Consequently, elective IOL should be performed with caution and the criteria of elective induction should be continuously reviewed as research is advancing.

Marshall, L. (2023). 'Obstetric Racism' Prevalent in U.S. Fueling Rise in Questionable Labor Inductions.   University of Colorado   Accessed https://www.colorado.edu/today/2023/04/26/obstetric-racism-prevalent-us-fueling-rise-questionable-labor-inductions

• While the increase in inductions among white women can largely be explained by an increase in higher-risk pregnancies among the white childbearing population, the same cannot be said for Black and Latina women, the study found. Instead, decisions about their care are being based on trends in the white population.

2022

• CONCLUDED: "Gives detailed explanation of what to expect during this stage of labor."

Carter, Channon, A., & Berrington, A. (2020). Socioeconomic risk factors for labour induction in the United Kingdom. BMC Pregnancy and Childbirth, 20(1), 146–146. https://doi.org/10.1186/s12884-020-2840-3  Accessed https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-020-2840-3

• The results presented above indicate that the risk of labour induction does indeed differ by socioeconomic status for women in the United Kingdom. Although nulliparous women are more likely to be induced, indicators of socioeconomic status such as maternal educational qualifications and electoral ward deprivation had more significant relationships with induction in multiparous women. The results of the present research highlight the importance of studying the influence of a woman’s environment and education on how she engages with health care practitioners and how she participates in medical decision-making."

2021

Dahlen, Thornton, C., Downe, S., de Jonge, A., Seijmonsbergen-Schermers, A., Tracy, S., Tracy, M., Bisits, A., & Peters, L. (2021). Intrapartum interventions and outcomes for women and children following induction of labour at term in uncomplicated pregnancies: a 16-year population-based linked data study. BMJ Open, 11(6), e047040–e047040. https://doi.org/10.1136/bmjopen-2020-047040   Accessed https://bmjopen.bmj.com/content/11/6/e047040

• CONCLUDED "IOL for non-medical reasons was associated with higher birth interventions, particularly in primiparous women, and more adverse maternal, neonatal and child outcomes for most variables assessed. The size of effect varied by parity and gestational age, making these important considerations when informing women about the risks and benefits of IOL."

2019

Rydahl, E., Eriksen, L. and Juhl, M. (2019). Effects of Induction of Labor Prior to Post-Term in Low-Risk Pregnancies: A Systematic Review. Accessed https://journals.lww.com/jbisrir/fulltext/2019/02000/effects_of_induction_of_labor_prior_to_post_term.7.aspx

• Induction prior to post-term was associated with few beneficial outcomes and several adverse outcomes. This draws attention to possible iatrogenic effects affecting large numbers of low-risk women in contemporary maternity care. According to the World Health Organization, expected benefits from a medical intervention must outweigh potential harms. Hence, our results do not support the widespread use of routine induction prior to post-term (41+0–6 gestational weeks)

• CONCLUDED "Results Induction of labor was associated with increased odds for cesarean delivery (adjusted OR; 99% confdence interval: 1.53; 1.45–1.60), operative vaginal delivery (1.21; 1.15–1.27), epidural analgesia (2.12; 2.03–2.22), fetal scalp blood testing (1.40; 1.28–1.52), retained placenta (1.32; 1.22–1.41), 5-min APGAR<7 (1.55; 1.27–1.89), umbilical artery pH<7.1 (1.26; 1.15–1.38), and admission to neonatal intensive care unit (1.41; 1.31–1.51). In a subgroup of induction of labor with the indication, “post-term pregnancy” induction was similarly associated with adverse outcomes. Conclusions In Austria, induction of labor is associated with increased odds of adverse maternal and neonatal outcomes. However, due to residual confounding, currently, no recommendations for treatment can be derived"

2014

American Public Health Association (2014). Reducing Non Medically Indicated Elective Inductions of Labor.  Accessed https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2015/01/23/09/03/reducing-non-medically-indicated-elective-inductions-of-labor

• Many commonly cited indications for labor induction are poorly supported by evidence, and patients often report that they are unaware of the risks and benefits of the procedure. Evidence suggests that there are no benefits to the mother or baby from an elective induction but that there are several increased risks, such as cesarean delivery. Quality improvement measures, such as establishing hospital protocols for scheduling inductions, have been shown to reduce the number of non-medically indicated inductions.

AWHONN (Non‐Medically Indicated Induction and Augmentation of Labor. (2014). Journal of Obstetric, Gynecologic, and Neonatal Nursing, 43(5), 678–681. https://doi.org/10.1111/1552-6909.12499 Accessed https://ilpqc.org/ILPQC%202020%2B/PVB/Toolkit/Induc/AWHONN%20Statement%20Induction%20Augmentation.pdf

• CONCLUDED "The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) maintains that labor is a complex physiologic event involving the intricate interaction of multiple hormones that should not be initiated or altered without a medical indication. Reserving induction and augmentation of labor for pregnant women with medical indications promotes the best health outcomes for women and infants and is the best use of health care resources. Women can make fully informed decisions about induction and augmentation of labor only when they understand the medical indications for induction or augmentation; potential harms or benefits associated with the pharmacologic and/or mechanical methods used to induce or augment labor; alternatives to induction or augmentation; and the benefits of waiting for and permitting labor to progress spontaneously. Administering exogenous hormones and performing mechanical interventions to a vulnerable population (pregnant women and their fetuses) is not advisable unless the benefits of these interventions have been shown to outweigh the risks".

• CONCLUDED "Scheduling births for non-medical reasons has become an increasingly common practice in the United States and around the world.We exploit a natural experiment created by child tax benefits, which rewards births that occur just before the new year, to better understand the full costs of elective c-sections and inductions. Using data on all births in the U.S. from 1990 to 2000, we first confirm that expectant parents respond to the financial incentives by electing to give birth in December rather than January. We find that most of the manipulation comes from changes in the timing of c-sections. Small birth timing changes, even at full-term, lead to lower birthweight, a lower Apgar score, and an increase in the likelihood of being low birthweight."

2013

Henderson, J. and Redshaw, M. (2013)  Women's Experience of Induction of Labor.  Accessed  https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/aogs.12211

• Women who were induced were generally less satisfied with aspects of their care and significantly less likely to have a normal delivery. In the qualitative analysis the main themes that emerged concerned delay, staff shortages, neglect, pain and anxiety in relation to getting the induction started and once it was underway; and in relation to failed induction, the main themes were plans not being followed, wasted effort and pain, and feeling let down and disappointed.

• CONCLUDED (from abstract) "The American College of Obstetricians and Gynecologists guidelines discourage elective deliveries before 39 weeks gestation, but clinicians continue to schedule elective inductions and cesareans resulting in births at 37 0/7 to 38 6/7 weeks gestation. These “early term” (ET) infants incur more morbidity and mortality than their 39-to-41-week counterparts."

• CONCLUDED (from abstract) "Among 7973 pregnancies that fulfilled the inclusion criteria, 343 (4%) had an elective induction of labor. Intravenous oxytocin was administered in 5% of these inductions, amniotomy was performed in 62%, and a cervical ripening agent was used in 33%. Electively induced labor more than doubled the risk of cesarean section compared with spontaneous labor onset (OR 2.5, 95% CI 1.4–4.2) and this risk was more than tripled when cervical ripening was used (OR 3.6, 95% CI 1.7–7.6). Conclusions. In low-risk parous women, electively induced labor has an increased risk of emergency cesarean section compared with spontaneous onset labor. This risk increase is more pronounced if cervical ripening agents are required. Women need to be counseled about these risks before elective induction of delivery is decided."

INTRODUCTION PAGE

Last Updated Feb. 2024