On page 53 of the 2006 National Vital Statistics Report (released Jan. 7, 2009), there was an interesting little chart: number of births by the day of the week. Not surprisingly, there were the fewest births over the weekend. Monday through Friday there were about 12,000-13,000 births per day; but on Saturday and Sunday there were only 7,000-8,000.
Of course, it shouldn’t be that way — there should be an even distribution. But there’s not. Reason being, that doctors are trying to practice “daylight obstetrics”, so they will induce or section a woman who doesn’t go into labor or give birth on their time table. I’ve read somewhere (but don’t have a link) that the birth rates right before holidays, especially long holiday weekends, is much higher than normal — doctors want to have the time off, so will make sure all the women they think might go into labor while they’re playing golf, or relaxing around the pool, or spending time with family, have already given birth before they leave.
Women should only be given C-sections when there is a medical reason. Women should only be induced when there is a medical reason. Women should only have their labors augmented when there is a medical reason. Any of these interventions done for non-medical reasons introduces medical risks to mother or baby for no good reason.
Is there any medical reason for inductions to be started on Monday through Friday and not on Saturday or Sunday? I remember reading someone’s birth story, and she said that she “had to be induced” for some medical problem, so went in on Friday. She wasn’t ready for labor, so nothing happened. So she was instructed to go home and come back on Monday or Tuesday to try for a second induction. Hmmm. How “medical” was that problem? I’d really be curious to know. It was “so medical” that she “had to be induced” one day… but then apparently not medical enough for it to be a problem over the weekend. Seems to me that if it was a problem on Friday, it would be a greater problem on Saturday and Sunday. But that’s just me. What do I know? I’m sure every obstetrician in America knows that medical problems only present half as much over the weekend (yes, I’m being sarcastic).
I’ve read too many stories of women who have found out after the intervention that the intervention that they were scared or coerced into agreeing to was actually not medically necessary — it was just done for obstetrician convenience. Stories of women who were told their babies were in dire need of a C-section… only to find out that it was really their doctor in dire need of getting home to dinner — that sort of thing.
One factor in the Monday to Friday induction/C-section rates is that hospitals are better staffed during daylight hours on the week. But why should that be? Of course, everyone wants off on the weekend and at night. That’s understandable. But birth shouldn’t be made to fit within those confines. It is understandable that elective pre-labor C-sections would be done M-F during office hours. But everything else…? Shouldn’t hospitals arrange staff so that they have more even distribution at all hours? It seems to me a vicious cycle — doctors section or induce during daylight hours because they have the most staff on hand during those times; and then because there are so many women being induced or sectioned plus those who go into labor naturally, that hospitals have more staff on hand during the day; then since there is more staff on hand during the day… You get the picture.
What if hospitals had the same number of nurses on hand at all times, 24/7? or nearly the same number? Would it change the picture of obstetrics? There is a type of obstetrician called a “laborist” — s/he’s an obstetrician who works a set schedule at a hospital, ensuring that there is an obstetrician in the hospital at all times. At the end of the shift, the person goes home, and another person comes on shift. If a woman hasn’t given birth, I would assume that it would be no big deal — the incoming laborist would be briefed about her situation, and take over labor-watching. That’s the way it is now with nurses — at the end of a shift, the nurse’s duties are over (although paperwork may not be!), and she can hand off the woman to the next shift. The way it is now, doctors are inclined to “hurry things up” so that they can be sure of when the woman will give birth, to make sure that they aren’t interrupted in the middle of the night to come and catch a baby, to be able to plan, go out to dinner, go to a movie, etc. If a woman goes into labor in the middle of the night, and is progressing normally but slowly, do you think the doctor will allow her to go 24 hours before giving birth? or do you think he’ll be at least a little bit tempted to have nurses augment her contractions so that she gives birth well before dinnertime, so he can go home and have a relaxing evening at home? I’m guessing the latter.
I blogged about a month ago about an L&D nurse’s blog post in which she mentioned having a woman have a completely natural labor (i.e., no induction or augmentation). This woman had gone into labor over the Christmas or New Year’s holiday, and the doctor was in no hurry to speed up her labor, because the doctor didn’t want to come in early and attend the birth. He was more than willing to let labor take however long it was going to take. He didn’t care about clock-watching… because he was home and wanted to stay there. But if he was at the hospital and wanting to get home, I daresay the situation would be quite the reverse.
Filed under: C-section, induction, studies & stuff Tagged: | baby, birth, inducing labor, induction, labor augmentation, labor induction, laborists, national vital statistics report, nvsr, nvss, obstetrician, obstetrics, pregnancy, pregnant