More controversial than delivering a pizza!

At the end of November I noticed this article in the Sydney Morning Herald. The article is about the alarm within health circles, specifically in New South Wales (NSW), Australia, regarding the jump in induced births throughout the state, both in public and private patients.

According to statistics sourced by the writer from the Ministry of Health website, in NSW in 2009 34% of women aged between 20 - 34, having their first baby, had an induced labour! 34% of women who, based upon their ages, are generally a lower risk group when it comes to pregnancy and labour!

Many women and their partners may not realise, and according to the article they may not have been told explicitly by medical professionals, that induction of labour greatly increases the risk of a caesarean, vacuum, or forceps delivery. In light of this it is not surprising to note that while caesarean and forceps delivery rates have increased in the state, the rate of normal vaginal deliveries has reduced.

Even as a nursing student I had pretty strong beliefs against the medicalisation of normal pregnancy and delivery. During my student clinical placements and employment in some of Sydney's leading private maternity units, I became increasingly wary of the way interventions were advocated during what were otherwise normal, low risk labours and deliveries. To my eyes it wasn't so much the midwives who were encouraging intervention, but the obstetricians. Inductions were common place in the units in which I worked, as were elective caesareans.

Just to be clear, I am NOT against medical intervention in pregnancy and labour if it is medically necessary. However, I feel that the increasing trend of medical intervention during NORMAL, low risk, pregnancies and labours is concerning.

I feel concerned about it for several reasons, including:

• that the medicalisation of pregnancy and labour discourages women to have faith in their bodies and what they have evolved to do naturally over the millennia. I want to be able to trust my body to do what it does naturally. I don't want to be told that my body is inadequate for the task simply because medicine has a "better" way of doing things. It is my firm belief that, when it comes to pregnancy and delivery, unless my body is medically incapable of performing its duties, medicine will only ever be able to compliment, rather than out do evolution.
• that people may be agreeing to treatment without fully understanding the procedure and the benefits and risks involved. I am a huge believer in informed consent, and I don't believe that people can truly and honestly consent to a procedure or treatment without entirely understanding the ins and outs of things. I also believe that in a hospital setting it is up to the medical professionals to provide enough comprehensive and unbiased information for a person to give informed consent, regardless of the procedure.
• that people may be opting for "convenience" to fit in to their own, or other people's schedules, and risking their own health, their child's health, and their chance to fully experience and enjoy the process of pregnancy and giving birth.

The day this article came out I posted it to my wall on Facebook. A 29 year old nursing friend of mine, who has recently had her own first baby, read the article and posted a very interesting comment about her own experiences with an induced labour. She was very regretful about her decision to agree to an induction, but felt that because her whole pregnancy had been medicalised (she had undergone IVF to conceive), she had to accept an induction. She said her experience with the Syntocin was "AWFUL!!", and wished she'd had more information before she agreed to an induction, especially after realising that the risk to the baby at the time was minimal. After an epidural and a forceps delivery she is now the proud mother of a beautiful baby girl. However, she is adamant that next time around she will make sure she is more informed before being forced to make crucial decisions about her labour and delivery.

The week following the release of this article, NSW Health released a set of guidelines for use in the states public hospital system regarding the induction of labour and the administration of Oxytocin during induction. These new guidelines clearly outline an Oxytocin dosage protocol to be adhered to by medical professionals, guidelines as to when induction is and isn't appropriate, as well as clearly stipulating that women being offered an induction must be explicitly informed that induction can increase the risk of caesarean, vacuum or forceps delivery.

It is an admirable step toward reducing the amount of intervention in normal pregnancies and reversing the alarming trend of normalising interventions in pregnancy and labour.

I am really interested to hear other people's opinions about this. What do you think?