Pre-Holiday Induction of Labor without Medical Indication

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By Jill

For the last few years, people have asked me for links about pre-holiday inductions. Here are the posts that everyone ends up passing around on Facebook, plus a few more.


Childbirth educator and About.com blogger, Robin Elise Weiss, has observed an uptick in pre-holiday inductions.

One of the things I’ve noticed year after year is that there is an increase in the induction rates just before holidays, but truly a lot of them occur before the winter holidays, oh and the end of the tax year. I remember one year I had three women due around Thanksgiving. One went into spontaneous labor the Sunday before Thanksgiving. One choose to be induced Monday morning so that she could be home in time for Thanksgiving (She was 38 weeks.) and the third choose to be induced that Tuesday for the same reason. I was crazy busy - but so were the hospitals. My clients who were scheduling induction kept getting bumped by others in the same situation. The real kicker here is that none of these women had medical reasons to be induced.

 

Lamaze’s Giving Birth with Confidence blog featured a post in November about the trend.

“Few doctors want to be pacing the halls on Thanksgiving or Christmas, waiting for a mother to deliver,” said Marilyn Curl, CNM, MSN, LCCE, FACCE and president of Lamaze International.  “So it’s not uncommon to see a surge of women with normal pregnancies being told that there might be an issue and that they should consider scheduling the delivery, coincidentally, right before a holiday.” 

It’s not just your healthcare professional who may try to rush your baby’s arrival.  Families often can feel stressed about the uncertainty of the baby’s arrival and feel it may compromise the celebration of holidays.  Some women also fear that their preferred healthcare provider won’t be available and will agree to a scheduled early delivery to guarantee that their provider will be available for the birth.

“I really understand that pressure.  You build a relationship with your care provider over the course of a pregnancy.  Plus, you build up expectations about your holiday celebration.  So it seems like ‘no big deal’ just to get the birth over with,” said Sue Galyen, RN, MSN, HCHI, LCCE, FACCE, a Lamaze childbirth educator from Brownsburg, IN.  “But it’s so hard to think that a scheduled delivery, whether through induction or cesarean, was worth it when either the mother or baby experiences a complication as a result.”

 

Lamaze lists red flags that may signal to a pregnant woman that she is being pressured into or feeling like scheduling an unnecessary induction and risking avoidable prematurity of her baby:

• The care provider suggests that the baby is too big and will be easier to deliver “a little early” 
• The suggestion is made that the care provider won’t be available for a holiday delivery or will be “booked up”
• The timing of the delivery is centered on travel and celebration schedules
• Holiday stress is driving feelings of wanting to get the pregnancy “over with”

 

Blogger Leah describes her experience of being offered a medically unnecessary induction.

Of course, this isn’t just a normal, uncomplicated time of year to be dealing with everything labor- and birth-related, what with so many planned events depend on this one UNplanned event: we have family coming in from out of town, out of state, and out of the country this month, and then there’s the whole stress of not just giving birth in the days before Christmas 2008 year but having a child whose birthday forever rubs up against the busiest time of the year every year. Everyone keeps telling me that I should take advantage of this excuse for not going all out with decorations and shopping and homemade gifts and baking (baking for others, at least) this Christmas, but I still can’t help thinking about what it will be like NEXT year, and the year after that and the year after that, when I have to throw in a birthday party on top of everything else. It would be so much easier if the baby were coming in early December rather than mid- or late December. Or, you know, July. (We’ve actually discussed the possibility of half-birthday celebrations to avoid this conflict.)

Which brings me to my point. At a prenatal appointment a few weeks ago, I was mentioning how very much I hope the baby comes early so as to make the whole holiday/family situation easier on everyone, and my doctor’s response was, “Well, when would you like to schedule an induction? Does December 7 work for you?” Although I was taken aback that she seemed not only willing but eager to accommodate me in this way, I was mostly surprised at my reaction to the idea of induction in general. I hadn’t ever seriously considered it before then, so I wasn’t quite prepared to have reacted the way I did, which was negatively.

 

Only slightly related is the CDC’s 2009 post, What’s your chance of having a Christmas baby?

The short answer is, not as high as in other months. Still, the possibility is there. In fact, if you look at the seasonally adjusted birth rates by month, your chances in December are just as good as having a baby in March or May. The lowest rate is April (13.7 live births per 1,000 population), compared with the highest rate in August (14.6). December comes in at 14.2 births per 1,000 population.

But this year, Christmas is on a Friday. How does that figure in? Well, the average number of births in 2006 (most recent data available) ranges from 7,587 live births on Sundays compared with 13,482 on Wednesdays. Fridays come in at a respectable 13,151, although Tuesdays and Thursdays, along with Wednesdays, have a higher average.

But then, that baby will come when it comes, right?

 

In the oft shared 2006 New York Times article, To-Do List: Wrap Gifts. Have Baby, David Leonhardt discussed tax breaks and the rise in December births.

 “[S]ince the early 1990s — the federal government has been steadily increasing the tax breaks for having a child. For parents to claim the full amount of any of these breaks in a given year, a child must simply be born by 11:59 p.m. on Dec. 31. If the baby arrives a few minutes later, the parents are often more than a thousand dollars poorer.

Unless you’re a cynic, or an economist, I realize you might have trouble believing that the intricacies of the nation’s tax code would impinge on something as sacred as the birth of a child. But it appears that you would be wrong.

[…]

“It’s phenomenal what’s happening in late December,” said Amitabh Chandra, a Harvard economist who provided many of the numbers here. “December is not really a particularly busy time for babies to be born. So to see a spike that’s equal to September is astounding.”

 

Jon Peltier of Peltier Technical Services, Inc., plotted data in response to the Leonhardt commentary in the New York Times and arrived at the conclusion that there is a “holiday effect” separate from the so-called “tax break babies” phenomenon because the New Year’s dip in numbers is not as pronounced as those at Thanksgiving and Christmas.

When a more complete record of the data is viewed, the assertion of the New York Times article can be examined more closely. It is obvious that births on 1 January are markedly lower than would be expected for the day of the week. Births on 25 December (Christmas Day) are also lower than expected for the day of the week, by an even greater amount than the New Year’s Day variation. In fact, the day of the year with lowest number of births is Christmas Day. Thanksgiving also shows a pronounced decrease in births compared to typical Thursdays, and perhaps more of an effect than New Year’s. The day of the year with the greatest number of births is either the Tuesday before Thanksgiving (as in 2000), the Tuesday before Christmas (1999), or the Tuesday before New Year’s (1998).

It is evident that more births are induced just before these three holidays, so the patients and doctors are not tied up during the holidays. I plotted data for the entire year 2000 to see whether this was true for other holidays during the year. The blue line shows the actual data, while the red line shows the value for each day of the week averaged over the whole year. Sure enough, while the general weekend-weekday pattern held for most weeks of the year, the chart below shows that Memorial Day, Independence Day, and Labor Day also had declines in number of births compared to the expected number for the day of the week. These declines were significant but not as pronounced as those on Thanksgiving, Christmas, and New Year’s Day.

Click over and scroll down to view this graph 

“Ask Kitty” columnist, Kitty Schindler, wrote the following a post titled Don’t short-change your baby by inducing labor on the TODAYMoms blog.

And that’s what disturbs me most about this trend: There are many valid reasons for inducing labor which mother and doctor can decide together, but CONVENIENCE is not one of them.

To bring a healthy baby into the world is such a joy; why take chances? Those last weeks, uncomfortable though they may be, allow further time for development of vital organs. What could possibly take priority over time to allow baby’s heart, lungs and brain to fully mature?

I say: Give your baby the best chance for a great start in life. Don’t short-change him or her in the final weeks of pregnancy after putting in so much time already.