As many of you will know, last June, after attending her pregnancy follow-up appointment, a woman who was in the 40th week of pregnancy, refused to undergo induction. As reported by Dona Llum at the time (association for a respected delivery), the gynecologist warned about possible risks of continuing the pregnancy (a pregnancy can be considered full term between 38 and 42), without offering more information to the pregnant woman.
What happened next left us astonished: the Parc Sanitari Sant Joan de Déu de Sant Boi (health center where the woman who still remains anonymous was treated) appealed to the courts due to Rosa's refusal - fictitious name -, and They sent a Mossos d'Esquadra patrol to the family home. In an exaggerated display of interventionism, it would well look like a scene from an American movie.
But no, it was as real as life itself, and the supposed urgency to induce was short-lived because after being transferred back to the hospital the future mother had to wait several hours until she was induced. These days, the news is spreading again, despite the fact that the baby will already be several weeks old, and among the media that talk about it, we find The Childbirth is Ours (EPEN), and we highlight some of the information they offer:
"The physical and moral integrity of a woman and her baby has been attacked without any legal basis and undermining freedom and the right to make informed decisions" El Parto es Nuestro
This entity also indicates that "the order is due to an illegitimate act and a misuse of power by obstetrician doctors", or that "They have violated dignity by making the judicial authority believe that they were more interested than the parents in protecting the life and health of the baby and that induction of labor was the only viable option.
If the lack of information provided by the hospital is true, Wouldn't it be true that women's autonomy has been denied? (taking into account that it is a right). We wanted to expand the information on labor induction a bit, and this is what we tell you:
Inducing labor is artificially ending a pregnancy.
When is it necessary to practice an induction.
La American College of Obstetricians and Gynecologists mention some reasons such as placental abruption (the placenta separates from the inner walls of the uterus before birth), infections such as chorioamnionitis, preeclampsia or eclampsia, pregnancy of more than 41/42 weeks, rupture of membranes (what we know as 'rupture of the bag') and death of the fetus.
ACOG tells us about the Bishop test to determine if the cervix is undergoing changes, but the score obtained (which can predict induction success) also takes into account the consistency of the cervix, as well as the height of presentation . In EPEN we find a document according to which a score equal to or less than 4 gives the information of an immature cervix that should mature using prostaglandins.
In any case, a pregnant woman must know the information related to these processes and have autonomy to make their own decisions, and must also consent to the interventions that are planned to be carried out.
It is useful to know that if an induction is not carried out carefully, there is a possibility that it will end in caesarean section, in 50% of the cases!Therefore, the medical staff must assess and that it is fully justified, and transmit such assessment to the mothers.
No inductions!
In the same way that there are situations that advise it, others have the opposite effect, so an induction should NOT be performed if:
- There is an invasive carcinoma of the cervix.
- The mother has active genital herpes.
- The fetal presentation is transverse or breech.
- Previous vessel: according to this informationIt is a rare heart-wrenching disease that occurs when one or more of the blood vessels from the baby's placenta or umbilical cord cross the entrance to the uterine canal, below the child.
- We find a providence of the cord (in front of the head).
- Or the placenta is a total occlusive previa / at term.
- There is absolute pelvic disproportion due to pelvic stenosis or structural abnormalities.
- Acute fetal distress has been observed
Pregnancy until week 40 ... and beyond?
The National Strategy for Sexual and Reproductive Health of the Ministry of Health, Social Policy and Equality, advises special attention to pregnancy between weeks 41 and 42 of gestation, to prevent this slight (but progressive) increase in morbidity and mortality expected from the gestational age of 41 and 42 weeks. Guidelines are established for these pregnancies, as long as they are low risk, such as:
- From week 41 + 0, the possibility is offered to wait for spontaneous onset or to perform induction, "WITH THE ADEQUATE INFORMATION for the mother.
- The woman who is offered an induction will make the decision with the complete information, and will have time to do so; must consent.
- When a mother refuses induction from week 41, it will be monitored frequently (two weekly controls).
- At any sign of fetal compromise, the pregnancy will end.
- A small percentage of pregnancies continue after 42 weeks (between 5 and 10) although the risks to the fetus are increasing.
- There is no evidence to advise induction on as or what date in a risk-free pregnancy, because while some dangers are discarded, others are manifested.
And it is that the induction of labor, in addition to being an artificial way to end a pregnancy is a very invasive procedure (and very painful). In the case at hand, the health center has not received complaints, and on the other hand, the baby was born on June 12, feeling perfectly well at the time of birth. I am left with that violation of the right to judicial defense indicated by EPEN, since the family was not given the option of contacting legal aid, and the baby has had rights restricted from birth, because parental authority, having parents, is held by them.