Uptick in Labor Inductions Amid Pandemic in Canada and the USA, a New Trend?

Groups representing pregnant parents say they are alarmed at the dramatic increase in the number of times labour has been induced during the COVID-19 pandemic.

According to a survey conducted by the groups, 48% of pregnant respondents said their labor was brought on early by induction, whereas before the pandemic, only 24.9 per cent reported the procedure. The survey was conducted by soliciting responses on the website accouchementpandemie.ca. A total of 267 women and expectant parents responded to the questions between May 5 and Aug. 10.

What we heard is that doctors and health professionals preferred to induce labour because they didn’t know what the situation would be in the hospital the following week,” said Sophie Mederi, the communications manager for RNR. “It’s definitely a bad thing, because we shouldn’t force a woman to go into labour when she doesn’t want it. It also goes against best practices to induce labor before 40 weeks, or without a medical reason.”

Mederi said inducing labour carries a higher risk for the delivery and can bring about complications, leading to cesarean sections and other problems.

The groups are asking the province’s health ministry to study the effect of the pandemic on the obstetrics profession. They are also urging the ministry and the province’s College of Physicians to remind doctors they should be reducing unnecessary interventions as much as possible for the best outcome for mothers and their newborns.

The survey also found stress was sky-high for pregnant women during the height of the pandemic, with 38.6 per cent of respondents saying they were under a lot of stress, while 37.1 were under a moderate amount of stress.

Reports in the United States find that the coronavirus pandemic has dramatically changed the patient experience. In most Philadelphia-area labor and delivery units, parents in labor are now allowed just one support person, must remain in their room during their stay, and can expect every doctor and nurse to be wearing extensive protective equipment. Not to mention the added anxiety about infection while at the hospital and about the virus’ unclear effects on pregnancy.

About a quarter of births at Temple University Hospital between February and June were by scheduled induction, a 17% increase from the same time last year, according to data provided by Temple.

The hospital has also seen a 20% increase in scheduled C-sections.

“I am concerned about the number of inductions and C-sections going up during the pandemic because any time you do an intervention, there’s going to be some kind of risk,” said Wadia Mulla, Temple’s medical director of labor and delivery.

According to the Journal of Perinatal Education Induction of labor alters the process of labor and birth in significant ways. The cervix often needs to be softened before pitocin (synthetic oxytocin) will be effective. Pitocin causes contractions that both peak and become stronger more quickly than naturally occurring contractions. The result is a labor that is more difficult to manage. In addition, the uterine muscle never totally relaxes between contractions, increasing stress on both the uterus and the baby. Because of the increased potential risks for the uterus and the baby, continuous electronic fetal monitoring is indicated. The fetal monitor and intravenous line make movement more difficult. The hormonal orchestration of labor is disrupted. Pitocin does not cross the blood-brain barrier; therefore, endorphins are not released in response to the increasingly strong and painful uterine contractions.

Acknowledging that babies can safely come 2 weeks before or 2 weeks after the due date does not tell the whole story. Some babies are mature as early as 37 weeks (259 days), and others need 42 completed weeks (294 days) and sometimes a bit more to be fully ready. Size is not an indication of maturity, and the due date is only a guideline.