by Christine Ramos, RN, BSN, CCE, CD, CBC

When Angela was 5 months pregnant she was diagnosed as having a mild case of symphysis pubis dysfunction, (a condition during pregnancy where the gap between the two pubic bones widens, causing discomfort or pain). During a routine prenatal checkup in her 34th week, Angela complained to her obstetrician that her pelvic discomfort was keeping her from having a decent night's sleep.

Her obstetrician readily assured her that in four weeks she would not have to endure the discomfort any longer. He planned on inducing her labor on her 38th. week of gestation. Though initially uncertain whether she wanted a medically induced labor Angela complied with her doctor's plan simply because she trusted his judgment. She figured if it there were any risks he would sit her down and discuss them, not appear so confident and unconcerned as he did during that visit in his office. Angela was scheduled for induction on the Wednesday of her 38th week.

But on that day it seemed as though her body and baby were simply not ready for the birth that was commanded of them. Angela did not respond well to the induction methods, (first cervical ripening, then Pitocin intravenously).

Her contractions were incredibly painful but despite her suffering her cervix dilated to only 4 centimeters. Though she wanted to try giving birth without pain medications she couldn't imagine enduring those contractions any longer. Angela tearfully requested an epidural.

And to top it off she was now bed-bound, unable to bear weight on her legs and attached to a fetal monitoring device when she had wanted to be free to walk during her labor. Fear and uncertainty came over Angela and her husband.

After ten hours of ineffective contractions her doctor announced that she'd soon have a c-section due to her labor failing to progress. The couple's baby could not tolerate the powerful contractions without soon being born they were told. In what seemed like a dream Angela was prepped for surgery and shortly afterward her son was pulled out of her uterus.

Instead of the immediate cuddling Angela had envisioned throughout her pregnancy her baby was temporarily whisked away to neonatal intensive care because of minor difficulty breathing. And instead of rooming-in with her son during the postpartum hospital stay as she had wanted Angela requested that he be cared for in the nursery as she was in far too much pain from her c-section.

Months later Angela could not help but feel anger and resentment toward her obstetrician. She subsequently learned how labor inductions lead to twice the likelihood of having a c-section.

So why didn't her doctor discuss these risks in statistical facts to her? Why did he appear so nonchalant over the idea of induction knowing the type of birth experience Angela wished for.

Sure her pelvic discomfort was a nuisance, but was induction a justifiable option compared to the risks involved? Of course she was grateful for the health of her son, but she couldn't help but wonder if she had been misled...

Angela is one of many as more and more women these days are consenting to the scheduling of their baby's delivery, with no medical rationale for it. The U.S. induction rate has more than doubled since 1989. Nearly half of postpartum women in a 2002 survey reported that some effort had been made to begin their labor. Yet interestingly, the World Health Organization recommends that no more than ten percent of pregnant women be induced. It is apparent that despite today's modern techniques, induction of labor still holds considerable risk compared to natural onset of birth. And most inductions are done for reasons simply not supported by sound medical research.

So what is the driving force behind this culture of birth-on-demand? It seems this trend is multifaceted but also reflecting a very revealing occurrence in this society. From the prevailing thought between traditionally trained physicians who believe the human body is a predictable bio-machine to the way how many now view things in life as needing to be convenient, time efficient, and fast paced, birth seems to be just another function to streamline. When presented in a certain way there appear to be certain perks to having a controlled birth:

• You can be sure to have your practitioner of choice at the delivery, (Dr. X will be not be on call the weekend of your due-date).

• You can arrange for your husband to be available and child-care for your other children while you're expected to be at the hospital.

• Want to make it to your sister's wedding with enough postpartum time to get back into shape? Easy! We'll schedule the birth the minute you're thirty-eight weeks.

Indeed, I can certainly understand the allure of a scheduled birth. Sometimes it is for the convenience of the doctor, other times for the patient. Some choose a controlled birth for reasons which seem to have a medical rationale. Many doctors will induce labor for a suspected big baby. This rationale has been shown to produce no benefits but instead increase the chances of having a c-section. Some physicians will induce a woman who's had gestational diabetes. To date there has been no credible evidence in support of this reason for induction. And of course there is the routine induction for the woman who is 41 weeks pregnant. What some may find startling is that there is no sound research which supports routine induction at any point in pregnancy.

Furthermore, experts believe that the median length of pregnancy in healthy first-time mothers is forty-one weeks, which means that a full half of these moms will go beyond their forty-first week of pregnancy.