Her first baby wasn't due for four days, but Misa Hayashi was advised by her obstetrician during a routine exam to check into the hospital that day.
"The doctor said the baby was too big for me to push out and we should go ahead and induce labor," says the Alhambra woman, 24. "I didn't really question it. Induction sounds so common. We went home and packed a bag and checked in at the hospital."
Once there, however, Hayashi's plans for an uncomplicated birth faltered. After receiving the drug Pitocin to trigger contractions, she labored for 20 hours. The pain was so intense she needed medication to ease it -- something she had hoped to avoid -- and eventually the baby became distressed, requiring constant monitoring of his heart rate.
Finally, almost a day after Hayashi entered the hospital, her son was born. Although he was healthy at 7 pounds, 10 ounces, Hayashi was left questioning the wisdom of labor induction.
Some hospitals and healthcare organizations across the nation share her concerns. Several have barred elective labor induction under certain circumstances, such as before 39 weeks of gestation (one week before the due date) or when there isn't clear evidence that the mother's cervix is primed for childbirth.
"There is renewed interest in these seemingly benign medical interventions," says Dr. William Grobman, an assistant professor of maternal-fetal medicine at Northwestern University. "But the topic is somewhat hazy. We don't have all the information we'd like to have about risks and benefits."
The move appears to be a push back against the trend in recent decades to medically manage childbirth. Fewer than 10% of women underwent induction in 1990, but more than 21% did so in 2004, according to federal government statistics. No one knows how many of those inductions were prompted by legitimate medical concerns. But various studies have put the number of inductions for convenience at 15% to 55% of the total number.
At the same time, rates of caesarean sections increased to more than 29% in 2004, up from 23% in 1990, with many women requesting elective C-sections -- surgical births without any medical justification. That trend too has generated debate about whether patients are undertaking unnecessary risks.
Labor induction is frequently, and legitimately, recommended when health problems complicate a pregnancy or when pregnancies are more than two weeks past the due date, obstetricians and gynecologists say. But sometimes the procedure is done solely for convenience. In a busy society, doctors and patients have grown increasingly comfortable with this practice.
