Labour inductions on the rise with associated risks
A risk management report by the Canadian Medical Protective Association (CMPA) revealed a rise in unnecessary labour inductions and the potential for “catastrophic injury” when the procedure goes badly. The CMPA reviewed 74 birth injury or mortality cases between 2002 and 2012 involving the administration of oxytocin used to induce labour. The Association expressed concern about patient care in 70% of non-legal cases presented by the provincial Colleges of Physicians and Surgeons. In the majority of legal cases, the physician was found to be at fault. Seventy-five percent of lawsuits resulted in a settlement.
Since the 1950s, oxytocin has been one of the most frequently used drugs in North America to stimulate contractions and induce labour. Despite its widespread use, the Institute for Safe Medication Practices labels intravenous oxytocin as a “high-alert” medication due to its potential to lead to maternal and fetal harm if used inappropriately. According to Dr. Dean Leduc, an Ottawa family physician, “the biggest problem is that people aren’t stopping [oxytocin]” in the presence of an abnormal fetal heart rate. The medication can cause too many contractions, diminishing the baby’s oxygen supply and lowering the baby’s heart rate. It can also lead to uterine rupture and umbilical cord prolapse.
Cerebral palsy (CP) is often the result of injury to the developing brain around the time of birth. A study published in the American Journal of Obstetrics and Gynecology of 7,242 children with spastic quadriplegic or dyskinetic CP identified six diagnoses associated with CP. Over 30% of children with CP had at least one adverse perinatal event associated with their delivery. This is significantly higher than the control group of children without CP (12.9%). The six diagnoses are broken down as follows:
These adverse intrapartum events are also the risks associated with oxytocin-induced labour. While the CMPA’s review of medico-legal cases did not specify the injuries resulting from malpractice, judging by these statistics it is likely that the rate of CP was particularly high.
The Society of Obstetricians and Gynaecologists of Canada (SOGC) insists that labour should be induced only when it is safer for the baby to be born than to remain in the uterus. For example, labour inductions are common in pregnancies prolonged beyond 42 weeks, or for a number of emergency complications including infection. However, inductions have risen in popularity partly out of convenience. Physicians and patients sometimes accelerate the birth process to accommodate their busy schedules. Figures from the Canadian Institute for Health Information (for Postmedia News) show that last year inductions accounted for 25% of all in-hospital births in Canada. The rate has more than doubled in the last 30 years.
The CMPA and the SOGC state that the physician must discuss with the patient the reason for induction as well as the risks and benefits. The physician must document the informed consent discussion. The patient has the right to be informed and have her questions answered before the induction. If labour was unwarrantedly induced and a birth injury occurred, the patient should consult a lawyer.
Further reading: Causes of Cerebral Palsy
- Canadian Medical Protective Association. Managing the risks of labour induction. Originally published March 2014. P1401-2E.
- Clinical Practice Obstetrics Committee. Society of Obstetricians and Gynaecologists of Canada. SOGC Clinical Practice Guideline: Induction of Labour. No. 296, September 2013.
- Mayo Clinic. Labour induction risks. 22 July 2011.
- Gilbert WM, Jaboby BN, Xing G, et al. Adverse obstetric events are associated with significant risk of cerebral palsy. Am J Obstet Gynecol 2010;203:328.e1-5.
- Kirkey, Sharon. Doctors’ malpractice insurer warns of risks of speeding up labour. Postmedia News. 23 March 2014.