August 23, 2011

Oregon Hospitals Act on Recommendations To Prevent Elective Births Before 39 Weeks

In recent years, attention has been focused on the issue of early elective inductions and cesareans – births that are scheduled, for no medical reason, before 39 weeks.  Because even moderately early births can result in worse health outcomes for newborns, organizations including the American College of Obstetricians and Gynecologists and the March of Dimes have recommended against them. However, such procedures continue to be performed far too often.

Now, seventeen hospitals in Portland, OR have decided to put a stop to elective inductions and cesareans prior to 39 weeks unless there is a medical need to do so.

This is an important step, and hospital policies can clearly reduce the numbers of early births.  But education for both prospective parents and providers is also important. Too often the media address the issue with the assumption that women are asking for these procedures. In “Rigging the Election: When it comes to elective induction, are women asking for it?, Amy Romano, midwife and member of the editorial team for the 2011 edition of Our Bodies, Ourselves examines this assumption and concludes that:

… this woman-blaming paradigm is simplistic and flawed. New research shows that, not only have maternity care providers failed to convey the risks of early delivery to women, they may be offering or recommending elective deliveries despite the risks, and telling women they have a medical reason for induction but documenting the inductions as “elective”.

It didn’t take long to find an example of just this treatment of the Oregon news: MSNBC’s coverage takes exactly that approach, framing the issue from the outset as one of women asking for something they shouldn’t have and being denied by the providers who know what’s best for them. It begins: “Beginning next month, many pregnant women in Oregon will no longer be able to have the early delivery they’ve been dreaming of.”

“Dreaming of?” No doubt, many women are uncomfortable toward the end of a pregnancy. I’d be interested, though, in how many women are presented with the option of early induction/cesarean but aren’t clearly told the possible risks of doing so. Perhaps it should be no surprise, but this point really struck me: that in a process controlled by medical providers – women don’t have access to their own induction drugs or operating rooms, after all – women are the ones being blamed for demanding medically unnecessary procedures that could potentially harm their babies.

I’d be interested in your own stories in the comments – did you have an elective induction or cesarean before 39 weeks? How was it presented to you?

Related post: we covered it in January when the Leapfrog Group released data on the practice.

Also, from the March of Dimes: Why at least 39 weeks is best for your baby (a guide for women), and blog posts from the Oregon chapter on the recent change.


2 Responses to “Oregon Hospitals Act on Recommendations To Prevent Elective Births Before 39 Weeks”

  1. Jessica A Says:

    I’m so so so glad to see this happening and wish other states in US, other countries that are like US follow suit with this. At the same time its one step of many in the right direction in this and etc along those lines.

  2. mrs spock Says:

    There are no hospitals in my area of Ohio that do elective induction or scheduled sections before 39 weeks. I had partial placenta previa this past pregnancy and though we did schedule a c-section, they would not have scheduled one prior to 39 weeks unless I had a complete previa or significant bleeding.

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