Born in the USA by Marsden Wagner

indications still apply to only a small percentage of pregnancies.
    The big debate today regarding inducing labor surrounds “post-term” pregnancies, or rather the point at which we can say that a pregnancy has gone too far beyond the normal due date of forty weeks’ gestation. Of course, birth can never be predicted down to a specific day. Rather, an estimate is made of the expected due date (EDD), based on the last menstrual period and/or ultrasound scans during the pregnancy, and the expectation is that the birth will happen
around
that time. Spontaneous birth between thirty-eight weeks and forty-two weeks is a perfectly normal variation. There is normal variation found with all biological events. In the case of human childbirth, the normal variation is two weeks on either side of the EDD, and babies born in this time period have no increased risks.
    A study published in 1963, using data from 1958, found that the number of babies who died in the uterus before birth increased slightly after forty-two weeks and then increased significantly after forty-three weeks. 31 After this study, there was a trend toward inducing labor if a pregnancy went more than forty-two weeks. However, only about 3 percent of pregnancies go beyond forty-two weeks. If we add “post-term” pregnancies to the list, that brings the total of scientifically valid medical indications for labor induction up to around 10 percent. Interestingly, that is just about what the rate was in the United States until about fifteen years ago, and it is also what the induction rate is now in many industrialized countries with excellent birth outcomes.
    Induction is a good example of an unfortunate characteristic of obstetric practice—a bandwagon effect whereby doctors jump on and the wagon gets going faster and faster, until everyone is afraid to get off. In 1982 and again in 1989, sound research was published that found no significant increase in neonatal mortality rates after forty-two weeks and only a slight increase after forty-three weeks, but the induction bandwagon didn’t slow down at all, it just kept going faster and faster. 32
    In 1996, a valid study was published that looked at 1,800 postdate pregnancies (pregnancies that went beyond forty-two weeks) and found no increase in baby deaths as well as no increase in complications compared with births of babies born “on time” at between thirty-eight and forty-two weeks. 33 But the bandwagon kept right on rolling. Small studies that show that inducing postdate pregnancies, rather than simply waiting for labor to begin spontaneously, resulted in slightly fewer C-sections are frequently quoted as a reason to induce, but these studies do not show that induction reduces the numbers of dead or damaged babies, only that it lowers the C-section rate slightly. (The risks of induction are generally understood to be less than the risks of C-section, so these studies are used to justify induction.)
    Induction reveals another characteristic of obstetric practice as well—a fear factor that often leads to a creeping overreaction in obstetricians. There seems to be a belief that if a little bit helps, a whole lot is even better. Induction was first done only at forty-three weeks’ gestation, but before long it was being done at forty-two weeks, and now it is creeping to forty-one weeks. Now we’re in big trouble, because forty-one weeks is entirely within normal pregnancy limits, and when we start inducing at forty-one weeks, we put large numbers of normal pregnancies at risk with an unnecessary procedure. At this point we have a situation in which the treatment is worse than the disease.
    The truth is that only about 10 percent of babies at more than forty-three weeks’ gestation get into trouble, but instead of treating these cases appropriately, we now induce labor long before the pregnancy gets to forty-three weeks with a powerful drug that has serious risks for both