Elective induction, patient choice, and physician preference

The CNM I am seeing recently wrote about how both patient choice and physician preference play into elective inductions. While she was doing her CNM clinicals a few years ago, she worked at a small community hospital that had two obstetricians (now there are four). At the time, it was common practice to do elective inductions at 37 or 38 weeks.

While working at Witham Hospital, I became well aware of how good physicians can obtain bad reputations from the natural birth community simply based on their induction rate. At the time, Dr. Winkler and Dr. McCarty were the two obstetrical providers in the practice and both held stern ground in not inducing labor without a genuine medical indication prior to 39 weeks. However, once reaching 39 weeks, most all moms were lining up for their induction, leading to a fairly high induction rate by World Health Organization standards.

It is quite common in obstetrical units for nurses to triage phone calls of clients sharing concerns that are nothing more than normal discomforts of pregnancy, yet they aren't seeking reassurance that their pregnancy is healthy and normal, but instead the perfect complaint that will justify an early end to their miserable pregnancy.

I distinctly remember being told by a pregnant mother that if the on-call physician did not induce her labor (at 37 weeks), then she would be happy to take her business elsewhere. The truth was she could go to any other local hospital and her wish would be granted. These two doctors declined her request and risked losing her as a client. They refused to put her baby and herself at risk, for the sake of her own convenience.

Not one of these physician's peers would fault them for inducing women earlier. They all did it in their own practice. Women want early inductions, and we're all about women's rights. However, they would have failed to withhold the oath, "do no harm." These physicians stood firm in the face of persecution and I was quite impressed.

Around the same time, one of the physicians discontinued his routine practice of artificially rupturing the amniotic sac in elective inductions. This would otherwise commit the client to birth, or more specifically, cesarean section because too often mom or baby simply wasn't ready. If the attempt to induce failed, this physician was comfortable telling mom after a day or two's effort to induce, "Sorry, we need to discharge you home as your induction was not successful. We can reschedule you in a few days." The nurses gave this physician a round of applause and many of us began to choose him as our own provider.