The Agency for Healthcare Research and Quality has recently issued a brochure on elective induction [ok, it looks like it went 404 on me, but here is a webpage with I think the same information on it, just not in brochure form]. The Family Way Publications has a good response about what’s wrong with the brochure. I would merely add that any time you choose an elective medical procedure, it only serves to introduce risk without a balancing or over-riding benefit. I agree with the rebuttal that the risks should be talked about in stronger terms, unless the brochure is not intending to dissuade women from an elective induction. I agree with being “fair and balanced” and trying to present both sides of the story, if that’s possible; but sometimes it’s not possible. What this brochure is doing is making it sound like a coin toss between waddling around for a few more days or weeks (which as far as I know, poses only mild and short-term discomfort for most women, and no long-term medical problem; if there is a medical problem necessitating induction, then that’s not elective), or choosing a medical procedure with known risks (including iatrogenic prematurity, more problems for both mother and baby during and after labor and birth, an increased risk of C-sections in first-time moms or those with unfavorable cervices) for no medical benefit. It shouldn’t be a coin toss. Weighing both sides of the issue in a balance, elective induction is a clear loser, and women should be dissuaded from that. The brochure does not seem to do that. It mildly mentions that women should wait until 39 weeks to be electively induced, but without a strong demonstration of the reasons why that is the best choice (certainly for the baby, who faces a doubled risk of NICU admissions, etc., at 38 weeks and a quadrupled risk at 37 weeks), women are left with the idea that the risks are about equal to the benefits, when that’s just not the case.
In fact, I wonder why they even put together this brochure at all. It seems to me that the only reason to do so would be to dissuade women from choosing an elective induction — after all, if the doctor suggests an induction, most women would think there would be some medical reason or benefit to doing it, and at the least would just be following the doctor’s lead. That may fit the definition of “elective” in that anything that is undertaken for no medical benefit is “elective”; but it doesn’t fit the narrower definition, of it being the mother’s choice, and I might add, the mother’s idea. Rather, it is the doctor’s idea, and the mother acquiesces. If I were to put together a brochure about elective induction, it would be with the idea of giving it out to women who are contemplating asking their doctor or midwife to end their pregnancy early, to dissuade them from so doing, not to leave them with the impression, “Six of one, half-dozen of the other.”