Induction at 39 weeks?
At the 2016 ACOG national meeting 2 physicians presented a controversial idea that “if we shouldn’t induce BEFORE 39 weeks, why not just induce everyone AT 39 weeks?” . Why would they do this? Well apparently they were inciting to riot.
Then to add to the fire, one of our local hospitals (Rochester General) decided to bring these doctors in to speak at City Wide Grand Rounds. I was invited to attend, as part of the board of the Institute for Family-Centered Childbirth, but was not able to. So I contacted a local OB/GYN/Researcher Dr. Chris Glantz (who is also on the board with me), to ask what happened.
“Hi Amy,
I am attaching a commentary I wrote this year for BIRTH, which pretty much sums up my thoughts.
Why Not Induce Everyone at 39 Weeks chris Glantz 2017
I have a whole lecture on the topic as well, which I offered to give at RGH as a counterpoint to yesterday’s presentation. Both of these were written in response to a presentation Drs. Norwitz and Lockwood gave last year at the ACOG national meeting, in which they concluded that the evidence “overwhelmingly” supported delivering all women at 39 weeks.
Yesterday’s grand rounds was effectively presented: Dr. Norwitz has a polished style and comes across as an authority. Unfortunately, he selectively and uncritically cited literature, inflated or minimized risks when it served his purpose, vastly oversimplified complex issues, mixed data with anecdotes, and never mentioned any role for pregnant women in the decision process.
He did leave time for questions and discussion. I was expecting (hoping) that audience members would challenge some of his assertions, but was disappointed when instead they mostly asked about methods of cervical ripening, how long to continue an induction before calling it unsuccessful, etc. – in other words, how to best accomplish these 39 week inductions! No residents or midwives spoke up. I finally raised my hand and said pretty much what I wrote in my second paragraph above. He seemed a bit taken aback, but listened respectfully. I then asked, given that his “39 weeks and out!” philosophy, whether he advises all his patients to be induced at 39 weeks. He said no. I asked, “Why then are you presenting this as if the issue is black & white, that 39 weeks was as far as a pregnancy should be allowed to go?” He basically said he thought the data were interesting, thought-provoking, and controversial (which they are, in a sense), and people liked hearing about the topic.
A few weeks ago this subject came up again at the ACOG District II conference, in which a panel supposedly discussing why the cesarean rate is so high digressed into whether electively inducing all pregnant women at 39 weeks might actually LOWER the rate. One of the presenters was Dr. Lockwood, who had been on the panel at last year’s national conference, and the other was a Dr. Nielsen who had done a study in 2005 that reported no increase in CS with elective 39 week induction. Neither panelist seemed to think high CS rates were an important issue. I contacted the NY ACOG office to voice my concerns about their discussion, and also that, by ACOG having various panels of a few “big names” who conclude that the best approach is to induce everyone at 39 weeks, it might appear that ACOG is tacitly endorsing this plan. Their response was interesting: “We have had a lot of feedback on the c-section panel…and I agree with your concerns.”
Chris”
John Christopher Glantz, M.D., M.P.H.
Take a moment to read Dr. Glantz’s article: Why Not Induce Everyone at 39 Weeks chris Glantz 2017
So why not automatically induce all women at 39 weeks? Because it is not evidence based maternity care. Inductions should only ever be done for true medical reasons. For more information check out this article, and take a Bradley Natural Childbirth class.
Have more questions? Contact Amy!
Amy V. Haas, BCCE
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