March 3, 2014 11:00

New standards curb elective induction

We are a culture of planners. We have apps to plan every second of our vacation and we have calendars on every device. Childbirth doesn‘t fit into the carefully constructed boxes of a perfectly planned life. And so we induce. In fact more than half of all babies enter this world thanks to induction in some way, shape or form. And not always out of medical necessity.

But new terms for what it means to be "full term" are shifting the tide, and guidelines in states like Louisiana are fostering a culture that accepts elected induction less.
In late 2013, the definition of "full term" changed - shrinking from between 37 and 42 weeks to between 39 and 41 weeks - thanks to standards published in the journal of Obstetrics & Gynecology and endorsed by the American College of Obstetricians and Gynecologists and the Society of Maternal-Fetal Medicine. 
It may seem a small thing, but changing the definition of full term means changing the time period in which an elective induction is acceptable. And changing that, experts hope, will lower the rates of C-sections and lessen time in NICU for babies taken too early. 
From lung maturation to a compromised immune system, evidence shows again and again choosing to induce early outside of medical necessity is bad for babies and bad for moms.
"Everything improves if you don‘t do elective inductions," says Women‘s and Children‘s chief nursing officer John Marker. "A lot of the research has been out there and looking at this. It‘s not just an arbitrary cut off. The longer you go to term the better you will be."
So the question remains if elective inductions are bad for babies and moms, why would any mother choose one. 
"It has been culturally acceptable to induce," Marker says.
The change in these definitions and guidelines like those in Louisiana that require a woman to go full term unless out of medical necessity are likely changing that culture.
It‘s a culture that developed out of what some might call necessity, particularly in South Louisiana where tight-knit families fear missing the birth and soon-to-be-dads who work offshore want to ensure they make it on delivery day.
"We are a culture of planners," Marker says.
When UL nursing professor, registered nurse and nurse midwife Helen Hurst began practicing in 1992 there was an upward trend in elective induction.
"There is a shift again and a big push from major organizations toward no inductions before 39 weeks that are elective because of the risk to the baby," Hurst says. 
So significant is this push that just three years ago Louisiana led the country in creating guidelines that no longer allow elective inductions before 39 weeks.
"Through a collaboration everybody signed on and said we are going to do what is best medicine. As a state we are going to adopt this and lead the way," says Marker. 
So unlikely was the choice (when is this state ever first on the good lists?) that the March of Dimes recognized Louisiana as being a progressive beacon in a movement toward encouraging women to go the full 40 weeks. The proof has been in the pudding - most recently Lafayette General Medical Center was ranked tops in the country for full-term deliveries.
"We are really pushing evidence-based practices, and organizations are trying to re-educate," Hurst says.
And more than ever, consumers should be knowledgeable about their health care choices. "It‘s very important as a consumer whether it‘s a heart condition or surgery that you understand the risk and benefits and make your decision based on the information," Hurst says. "That‘s why it‘s called informed consent."

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