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Winnipeg Free Press - PRINT EDITION

When it comes to birth, let nature take its course

Doctors say forced labour carries risks

By: Sharon Kirkey

Posted: 06/15/2009 1:00 AM | Comments: 0 (including replies)

Leaders of Canada's pregnancy specialists are urging doctors not to induce labour unless there are compelling medical reasons.

The call is part of a campaign to "normalize" childbirth and efforts to reduce Canada's soaring caesarean section rate. Some studies suggest inducing labour in a first-time mother significantly increases her risk of a C-section.

Inductions accounted for 20 per cent of all in-hospital births in Canada (excluding Quebec) in 2006-07, according to the Canadian Institute for Health Information. In 1980, the rate was 11.9 per cent.

Doctors say several factors are driving induction rates, including the number of older first-time mothers, medical legal concerns and convenience.

"(Women may say), 'My husband is going somewhere, can't you get my baby out Monday?'" said Dr. Andre Lalonde, executive vice-president of the Society of Obstetricians and Gynaecologists of Canada, which will hold its annual meeting this week in Halifax.

For most expectant mothers, labour begins spontaneously at about 40 weeks into the pregnancy.

Induction of labour occurs when medications such as prostaglandin and oxytocin are used when a woman is past her due date to ripen the cervix and get the uterus contracting.

"The message to doctors, nurses and midwives is, be patient and do not consider inductions before the end of the 41st week," Lalonde said. "If you wait that extra week to 10 days, you will find that most women -- a large percentage -- will go into spontaneous labour."

He says "the No. 1 risk" of induction is that it leads to earlier decisions about a C-section, which now stand at an all-time high in Canada. Nearly 28 per cent of babies were born surgically in Canada in 2007-08, a national report released last week said.

That's up from five per cent in 1969.

"Once you have used certain methods, such as rupturing the membrane (breaking the waters), we know that you have to have a delivery within 12 hours, otherwise it increases the risk of infection," Lalonde said.

Induction can lead to longer, more painful labour and continuous electronic monitoring of the baby's heart rate, which itself increases the risk of C-sections, because it generates "a lot of information. In fact, too much information," says Dr. William Ehman, a family doctor in Nanaimo, B.C., who will be leading a session on normal birth at this week's meeting. "So you are trying to sort out the important things versus what's not important."

Research shows that in healthy pregnancies, checking the baby's heart rate after contractions by listening or using a hand-held device, reduces the risk of interventions. But a recent Canadian survey of more than 6,000 women who have given birth in the last few years found most women (91 per cent) experienced electronic fetal monitoring during labour -- including 63 per cent who had continuous electronic monitoring.

Ehman worries that women and their doctors have lost confidence in the ability to give birth without technological interventions.

"The sense of letting nature decide, I think we've lost a little bit of that, because everything is so planned down to the minute," he said.

Families watch the clock as the pregnancy approaches the due date and if women start to go over, a nervousness settles in.

"People start calling them. 'Why haven't you had your baby?'"

"We know the evidence is clear that, overall, you do much better for the women by not offering induction until after 41 weeks. Nature prepares the uterus better than we can," Ehman said.

-- Canwest News Service

Republished from the Winnipeg Free Press print edition June 15, 2009 A9

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