cesarean section – Doula Group of Evansville

1. Sometimes Induction is Necessary.

High blood pressure, blood sugar control issues, protein in your urine, health concerns for the baby, and more can make it healthier for your baby to be better on the outside than on the inside. These are very valid medical reasons to be induced. Some providers prefer inductions to take place because of suspected big babies, low fluid, getting close or passing your due date, and other reasons. As we know from the evidence, these are NOT medical indications for induction.

2. You CAN Say No.

If everything is fine with you and the baby, then it is perfectly ok to say no to an induction. Even if you are in the hospital for an induction, you are STILL allowed to say no to anything that they offer, and you should be having a true informed consent and refusal discussion for each and every procedure. This includes breaking your water, starting medications, cervical exams, internal monitoring, the type of cervical ripening medication, and ANY TIME someone wants to touch you! Signing up for an induction does not mean you leave your autonomy at the front door. You’re still the boss applesauce!

3. Induction Increases Your Risk of Needing Cesarean Surgery.

Yes, there was ONE study that found that inducing everyone at 39 weeks reduces the cesarean rate, which actually was really problematic. I have discussed this previously along with a BUNCH of other scholars, however there is far more research that says the opposite. I really appreciate Dr. Sara Wickham’s resources on induction for help making informed decisions. This is something that needs to be discussed before you agree to any induction, no matter why it is being advised.

4. Induction Affects More Than Just When the Baby is Born.

Induction is forcing your baby and body to do something before they are ready to do it on their own. Most due dates are an estimate, and none are expiration dates, as babies keep developing even after they are born. Induction interrupts the hormonal physiology of birth, as Dr. Sarah Buckley has published on extensively. Interventions also affect breastfeeding, which can make feeding your baby more challenging after an induction. This needs to be part of the discussion when you are weighing the risks and benefits of whether to choose an induction.

5. Induction Can Take a LONG Time.

Especially for first time parents, induction can take a really long time. Locally most inductions start overnight with a cervical ripening medication and then proceed the next day. Will you be allowed to eat and/or drink during that time? Will you be allowed to take a shower? Will you be on the monitors the entire time? When are you allowed to get an epidural if you want one? Will your provider be there the whole time? What kind of time limits will they put on your progress? Will there be breaks? Can you bring your Fire Stick to keep watching your current favorite binge-worthy show? Ask questions to help yourself make the most informed decisions regarding your care!

The bottom line is this: If your provider is recommending induction, have an open and honest conversation with them using the BRAIN acronym:

Benefits–what are the benefits to this?

Risks–are there any?

Alternatives–what else could we try?

Intuition–what does your gut say?

Nothing–what happens if we wait?

Only YOU get to decide what is the right choice, and we want to make sure everyone goes into birth and parenting with their eyes wide open from the beginning. Want to do some more digging before making a decision about an induction? Asking for TIME can be the most empowering way to step away from what can be a high pressure feeling power imbalanced situation when you are sitting there with your pants off talking to your provider. We talk to clients about this all the time, so feel free to give us a call for a consult if you want a little help!

Statistics tell us part of the story of how a hospital cares for their patients and about the culture of a place. They do not tell us the entire story in any way shape or form, but they are a way to measure change and track goals. Leapfrog is a group that tracks statistics about hospitals around the country using a survey that 75% of hospitals participate in each year. Today was the day that they published this data for 2020.

You can find the 2018 Statistics in this post we wrote. I did not write a post for 2019’s statistics, but I think we all remember April 2020 right? You can look these statistics up for yourself here, because you really don’t have to just take my word for it.

Definitions & notes for you:

This Cesarean Section data is for NSTV (research speak for 1^st time parents, 38+ weeks pregnant, with a single head-down baby) cesarean rates and does not include repeat cesarean deliveries or 1st time cesarean deliveries in people who have had previous vaginal deliveries. This is an important distinction. Leapfrog Group uses the Healthy People 2020 goal of 23.9% for primary cesarean deliveries in this category. I want to note here that the WHO stated target NSTV cesarean rate is 10-15%, so that is something to also think about when looking at this data.
Early Elective Deliveries are defined as elective induction or cesarean sections before 39 weeks. This does not include medically indicated early deliveries, therefore the goal is for these to be less than 5%.
Episiotomies are a cut made to the perineum during the birth process. While sometimes necessary, routine episiotomies are not evidence-based practice, and Leapfrog sets their goal as less than 5%.
The numbers in (parentheses) are the previous numbers reported in 2018. I did not include numbers for Good Samaritan Hospital previously, so apologies to our friends in Vincennes for the lack of change comparison possible in this table.
New numbers that reach or exceed the Leapfrog goals are in blue.

Hospital	NSTV Cesarean Sections	Early Elective Deliveries	Episiotomies
The Women’s Hospital Newburgh, IN	26.2% (22.9%)	6.8% (1.7%)	11.5% (14.8%)
Ascension St. Vincent Evansville*	25.3% (27.2%)	0.0% (.8%)	5.9% (6.8%)
Owensboro Health	29.5% (29.7%)	.7% (1.4%)	5.7% (12.7% )
Deaconess Henderson Hospital**	25.5% (26.1%)	0.0% (2.4%)	2.8% (2.4%)
Memorial Hospital & Healthcare Center Jasper, IN	11.1% (12.8%)	5.9% (0.0%)	7.9% (9.8%)
Daviess Community Hospital Washington, IN	17.9% (15.2%)	0.0% 1.9%)	8.2% (13.1%)
Good Samaritan Hospital Vincennes, IN	20.7%	4.0%	14.2%

*Previously St. Vincent’s Medical Center of Evansville
**Previously Methodist Hospital of Henderson

What the Numbers Don’t Say

What these numbers don’t say is what an incredible strain 2o20 was on all hospitals, including in maternity care. While there were clearly jumps in early elective deliveries at Memorial in Jasper and The Women’s Hospital in Newburgh, we don’t know when those happened. Were those elective deliveries in March and April last year when everything was locking down due to the growing pandemic and people were truly scared for their lives? Conversely, maybe the pandemic was an easy excuse to push for early elective induction too. We can’t know that from the numbers. These statistics represent thousands of birth stories that we can’t know just by reading them.

These statistics are also not the only ones worth looking at when making decisions regarding your care. Other important factors such as VBAC success rates, availability of lactation help, availability of anesthesia, proximity to your home, provider access, insurance coverage etc. Sometimes that last one ends up being the deciding factor no matter what your preferences are on location.

How to Use These Numbers

First use them to think about where you want to deliver. You do have options and choices on where to go, and we would be happy to talk to you about our experiences at these places as well. Know that these are overall statistics that paint a generalized picture, and start there. Even if you don’t have a choice on where to go to birth, because we know that happens, these statistics can help you look at the norm where you will be delivering. They can help you know what to expect and watch for during your delivery.

Next use the numbers to start a conversation with your provider. Where do they deliver? What are their personal statistics compared to the facility? How do they feel about episiotomies?

We ALWAYS encourage everyone to have open, honest, and frank conversations with their providers. Don’t be intimidated by the white coats, they are people too. Keep it positive and be inquisitive, and go with your gut when it comes to making decisions regarding your provider and location for delivery.

We look forward to comparing 2020 with 2021 when those numbers come out!

What is the first question that comes to mind looking at this table?
Do any of these numbers surprise you?
Which of these statistics most line up with what you previously thought about these facilities?

Tag: cesarean section

5 Induction Truths