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An inconvenient truth Labor & Delivery

An inconvenient truth

Scheduling baby's birth day may appeal to nervous or busy moms-to-be, but is an elective C-section or induction really the best choice?

When Roslyn Jin was pregnant with her second child, she thought long and hard about the best way to give birth. The mother of two in Ontario, Canada, had a less-than-ideal first birthing experience, which began spontaneously but ended in an emergency C-section, so the idea of scheduling the birth of her second child was very comforting. After consultation with her doctor, Jin decided that an elective C-section would be best.
“Medically, it wasn’t necessary,” says Jin, “but I knew there was a good chance I would end up with another C-section even if I went into labor on my own. By the time I was in my last trimester, all that mattered to me was giving birth to a healthy baby, no matter how I gave birth to her.”

Many women like Jin are electing to have more control over their deliveries by scheduling a C-section. In 2012, an estimated 33 percent of all births in the U.S. were by cesarean, and the majority of these were attributed to “convenience” reasons.

But many medical professionals suggest that planned births via an induction or C-section without medical cause are unnecessary and undesirable. Here’s a look at what to consider when it comes to your own delivery.

In control
For many women, the “unknown” is the most frightening part of giving birth. A University of British Columbia study found that one-fourth of pregnant women reported high levels of childbirth fear. Even mothers-to-be who have attended birthing classes, watched childbirth movies and pored over their birth plans are likely to be nervous about delivery.

For many of these women, a scheduled induction or elective C-section for non- medical reasons, also known as a “convenience” birth, may sound appealing. A convenience birth allows labor to be scheduled and planned, often to the exact day, and provides mothers with some measure of control over the manner in which they give birth.

The reasons that mothers-to-be consider a convenience birthing experience vary but can include being tired or overwhelmed by pregnancy, distance from a hospital, a previous negative birthing experience, the doctor’s availability or simply the comfort of knowing exactly when they will give birth.

A convenience birth may also allow for vacation days to be taken and care for an older child to be arranged ahead of time, making it a more palatable option for working parents with a lot to organize. As our calendars have gotten busier, C- section rates have continued to rise.

Planning pros and cons
While a convenience birth allows moms-to-be to choose—within reason—when they will deliver and how they will give birth, it might not be the best choice.

In fact, most medical professionals say it isn’t. David A. Luthy, MD, medical director for obstetrics and gynecology at Swedish Medical Center in Seattle, cautions expectant patients to be well-informed and carefully consider the cumulative risk of choosing to induce a birth for non-medical reasons before making any decision.

He points out that research shows an elective induction or C-section should not be considered before the mother is at least 39 weeks pregnant and has a favorable cervix. Mothers-to-be should be aware that choosing to induce birth can lead to an increase in the need for a C-section or other invasive medical interventions, and it often results in a longer hospital stay. Alternatively, choosing to give birth via elective C-section requires major surgery and many weeks of recovery time postpartum. A C-section also carries its own potential risks and side effects, including infection and scarring, along with an increased cost to the patient.

Vivian E. von Gruenigen, MD, system medical director for women’s health at Summa Health System in Akron, Ohio, echoes the sentiment that spontaneous labor is best, advising that “although it may ease some fears, elective induction of labor is not the best choice for most women.” She recommends that scheduled inductions and C-sections only be considered when deemed medically necessary.

And while doctors are ethically permitted to abide by a healthy, pregnant woman’s wishes for a convenience birth after 39 weeks of pregnancy, the American College of Obstetricians and Gynecologists (ACOG) cautions that, “labor should be induced only when it is more risky for the baby to remain inside the mother’s uterus than to be born.”

Does mom know best?
The truth is that some women who have scheduled a convenience birth experience feelings of guilt or regret following their choice. Beth Hayes (name changed to protect privacy) of Gloucester, Virginia, opted for a convenience induction after a long, hard pregnancy. While she and her baby were both happy and healthy at the end of the day, she says she would do things differently if given the chance for a do-over. “Now that I’m more aware of the risks associated with unnecessary induction,

I realize that I didn’t need to take those chances,” she says. “I was just tired of being pregnant!”

On the other hand, many mothers are happy that they chose to have some degree of control over when and how they delivered. For example, while Jin did not desire anything but a “natural” birth for her first child, she has not regretted her decision to have an elective C-section for her second. She says she felt calmer and more prepared to give birth once it was planned.

Pauline Hull of Denville, New Jersey, who gave birth to both her children via elective C-section, says the decision to have a convenience birth was the right one for her. “I instinctively knew I wanted a cesarean birth even before I was pregnant. It felt like a very natural and normal choice to me,” she says. Hull is quick to point out, however, that her choice was an informed one and is certainly not for everyone.

The end goal
While opinions on convenience inductions or C-sections vary, there is agreement amongst medical professionals that there is no such thing as a “perfect” way to deliver. Childbirth is complex and different for every pregnancy.

Vicki Nolan Marnin, MSN, CNM, owner of Birth & Beyond in Madison, Connecticut, reminds moms that even if a birth is planned to a T, Mother Nature can still step in and change its course. “No birth is ever perfect,” she says, “even the preplanned ones! Never be completely set on giving birth one particular way.” Instead, care during pregnancy and delivery should be individualized to the needs of that particular mother and baby, ensuring they receive what they require to achieve a successful outcome.
In the end, the primary goal of childbirth should always be that a baby is born healthy and into the arms of a loving family—no matter how the bundle of joy arrives.

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