Google+ Authentic Parenting: Medical necessity? (rerun)

Saturday, January 22, 2011

Medical necessity? (rerun)

I was reading this article this morning, which stated in its introduction that:
"Pregnant women tempted to induce labor for convenience rather than medical necessity may want to wait for nature to take its course."
First I thought: "Well, duh!". But then again, my mind wandered and I started wondering about "medical necessity" for induction and related procedures. To me that term is about as dubious as "high risk pregnancy", but maybe we'll save that for another post.
Don't get me wrong, I'm not claiming that there never is a medical reason for intervention, and I am very happy we live in a world where modern medicine is practiced and death in childdbirth has been reduced to a minimum. Yet I am all for a conservative approach in pregnancy and childbirth and against the overusing high-tech procedure with no evidence to back it up just because it's there, it's new, it's man-made, so it must be better than what nature designed. That's not medicine, that's Inspector Gadget.
The article ended by giving us a non-exhaustive list of conditions where induction is a "medical necessity":
"Try to reserve interventions for situations where risk outweighs benefit," said Glantz, such as in cases of diabetes, high blood pressure, problems with the placenta, a baby that is not growing well, or a woman being 10 days past her due date."
And this is where I was getting at!

Let's just assume that we're talking about true diabetes here, to not get into the "gestational diabetes might not be an illness"-debate for now (got to save something for a later post).
The main reason for induction with Type I diabetes is supposed macrosomia (large baby) and possible related problems (shoulder distocia and birth injuries), yet induction for the mere reason of macrosomia is being severely debated, because a) prognosis of macrosomia are iffy to say the least, b) induction for macrosomia fulfils none of its esteemed goals (to prevent shoulder distocia, c-section or birt injuries)
An underlying reason (which your doctor proably won't tell you) of induction for Type I diabetes is having the staff handy for the GLYC/INdrip, which regulate blood sugar levels during childbirth. (They need a diabetologist and an experienced midwife for this, and you couldn't expect them to get out of bed at your baby's terms). Now about the glucose-insuline drip: most women need to be administered no or very few insuline during labour, because labour is in itself an intense physical activity, which lowers bloodsuger levels. Glucose is often administered, but merely because of the fasting rule hospitals apply. (Yet again, even the glucose-insuline drip is not standard in all hospitals)
Another point worth considering is that there is no policy about induction for diabetes. Measures taken vary greatly between countries, even within countries and sometimes even within one and the same hospital, considering your physician. Some induce two or one week before due date, some at due date, some don't.
A 2002 article in Journal of Maternal-Fetal and Neonatal Medicine sums it up nicely:
"Currently available evidence suggests that, while induction of labor for women who have diabetes may not carry much maternal or fetal risk, the benefit of this procedure is unclear."
If there is no clear benefit, why do it?

Past due date
The 40 week gestation is a flawed system, based on a false interpretation of the bible, which stated that a pregnancy would last for 10 lunar months, which was then interpreted by Naegele around 1812.
"Strictly speaking, a lunar (or synodic - from new moon to new moon) month is actually 29.53 days, which makes 10 lunar months roughly 295 days, a full 15 days longer than the 280 days gestation we've been lead to believe is average. In fact, if left alone, 50-80% of mothers will gestate beyond 40 weeks."
Less than 5 percent of all women give birth on their due date.
Another problem calculaqting due dates is that not all women have a 28 day cycle, neither do all women ovulate on day 14 of their cycle.
If a baby is delivered at 40 weeks plus ten days, he might even be a couple days pre term.
The original article talks of 10 days overdue, yet the term one can go overdue without going into the "medical necessity" zone also varies among diferent countries. For the American College of Obstetrics and Gyneacologists, a pregnancy shouldn't be meddled with until it is at 42 weeks gestation.

Read more:
Induction for big baby
management of diabetes in pregnancy (schotland)
calculating due date


1 comment:

  1. I was carrying Ben back in 2009 and during my last gynae check-up, my gynae mentioned I had low amniotic fluid and suggested that I admit myself and go for labor induced. Of course I was very hesitant as I know inducing = forcing baby to come out when it's not his time to come out!

    Our gynae mentioned that my baby is at full term already and told us to consider as he gave me 1 more week (based on the amount of amniotic fluid he scanned) to which, if I admit to hospital by then I'd definitely had to go for C-sect.

    More horror... needless to say, we went back home, while considering about the situation, I didn't realised my contractions started and by the time we decided to go to the hospital the same night to be induced, I reached the hospital with 1cm dilated and 4.5 hours later, gave birth naturally to my boy!

    Thank God for the natural delivery and that I didn't end up being induced!


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