Labour inductions up in Canadian hospitals
Doctors’ association warns of dangers
As doctors speed up labour for more and more pregnant women, growing concerns about inductions has led the national body defending doctors accused of negligence to warn of “catastrophic injury” or death for babies when inductions go badly.
A review of 74 cases between 2002 and 2012 involving the administration of the powerful drug oxytocin during labour found numerous problems, including delays in detecting, appreciating and acting on an abnormal fetal heart rate, inductions performed for no medically valid or compelling reason and insufficient staff to monitor a woman being intravenously infused with oxytocin.
“In these cases, the clinical outcome for babies was often a catastrophic injury or death,” according to the Canadian Medical Protective Association, or CMPA. Observers stress the cases account for only a slim fraction of the tens of thousands of inductions that occur each year in Canada.
“Things that turn up at the CMPA all have a bad outcome. That’s why they’re at the CMPA in the first place,” said Dr. George Carson, director of maternal fetal medicine at the Regina Qu’Appelle Health Region. “I would prefer it to be zero. But it’s necessary to understand that the vast majority of inductions are associated with a good outcome.”
However, the review found evidence supporting growing concerns about the rising number of unwarranted inductions.
Figures compiled by the Canadian Institute for Health Information for Postmedia News show inductions accounted for 25 per cent of all inhospital births in Canada in 2012-13. In 1980, the rate was less than half that. Older first-time mothers and more women with high blood pressure and other health problems are some of the factors driving inductions, experts say.
But some inductions are being performed purely out of convenience. “The woman says, ‘I want to be induced by such-and-such a date,’ or, ‘my pregnancy is uncomfortable, make it stop,’ ” said Carson. “And, occasionally, it will be the physician who says, ‘I’m going away on holidays next week, I want to get this delivery done.’ It’s rare. It still happens. It’s regrettable.”
“I think we need a whole society view that pregnancy is a normal physiological event and that the best thing to do with it is let it be,” he said.
Carson said labour should only be induced in cases where “there is some good reason to believe that the baby would be safer out than in.”