In the last weeks of pregnancy, women often plead for a little help to get their labor started.
"Their back hurts, they're uncomfortable, and they can't sleep," said Debbie Cates, a nurse and director of women's services at North Hills Hospital in North Richland Hills. "I have them all the time asking me, 'Please, can't you just do something?'"
At North Hills, the answer is always no for elective induction. A new policy limits induction for women who have not reached their 39th week of pregnancy.
"There are medical reasons when it is best to induce," Cates said. "But a physician's golf game or a mom who's just tired of being pregnant are not medical indications."
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The policy change, made in January, comes as elective inductions are on the rise in the United States despite warnings that it's healthier to let nature take its course.
Roughly 1 in 5 childbirths in the U.S. is started artificially with medication. The rate of induced labor more than doubled from 1990 to 2006, from 90 per 1,000 births to 225 per 1,000. A 2003 study found that the rate is as high as 76 percent among some doctors.
Recent years have seen an effort to reduce elective inductions, which typically use synthetic oxytocin to speed up labor.
The March of Dimes has called on hospitals to voluntarily limit cesarean sections and inductions before 39 weeks. The American College of Obstetricians and Gynecologists recommends that the fetus be at least 39 weeks or that lung maturity be established before inducement.
Last year, Andrews Women's Hospital at Baylor All Saints Medical Center instituted a policy preventing inductions before 39 weeks except when medically necessary, administrator Janice Whitmire said. The hospital is working with the National Institutes of Health on an inductions project.
But the decision is often left to the doctor.
It's really between the physician and the patient, said Megan Brooks, spokeswoman for Texas Health Arlington Memorial Hospital.
Although Texas Health Harris Methodist Hospital Fort Worth has no formal policy, demand isn't very high either, perhaps since many of the women have high-risk pregnancies, hospital spokeswoman Whitney Jodry said.
"We don't see a lot of women in their 36th or 37th week who want to be induced because a lot of our patient population is high-risk and they wouldn't choose to go into labor early," she said.
Still, plenty of women pressure their physicians to induce labor, often as a matter of convenience.
Maybe their mother is going to be in town that week or their husband can stay home, Cates said. Some want to make sure their obstetrician is available for the delivery.
In a world where parents schedule everything from ballet classes to play dates, it should come as no surprise that they want to plan their baby's birth as well.
"Our culture has moved into everything being a planned event," Cates said. "We forget that Mother Nature actually determines pregnancy, and she set it for 40 weeks."
Those last weeks can make a big difference in the baby's health. That's when the baby gains weight and its brain grows.
Babies born even a week early sometimes have trouble breast feeding and are harder to wake up.
Inducing labor also comes with a price for the mother.
Women who are induced often have prolonged labor and longer hospital stays and require more pain medication. In some cases, it can lead to a C-section.
"Their bodies are just not ready, and I can give them all the Pitocin in the world and it might not make their uterus contract," Cates said. "The body needs a full 40 weeks to get ready to be able to labor."
To complicate matters, few women know their exact due date and are often off by a week or two.
"If we're looking at inducing someone at 38 weeks and we're off by two weeks, we may be inducing at 36 weeks," Cates said. "That's huge and can put the baby at additional risks for breathing and feeding problems."
JAN JARVIS, 817-390-7664