It was great news for Canadian women when on February 16 Robert A. Burns,
MD, Executive Director of the Alberta Medical Association announced that
the AMA's Alberta Clinical Practice Guideline for induction of labor will
now include a strong recommendation that informed consent take place before
the procedure is initiated.
This precedent setting move will give women across Alberta the ability to
choose whether to subject their baby to the risks and side effects that may
be caused by birth induction or perhaps to use a natural alternative, such
as medical watching and waiting. It has been reported that until now some
women have been coerced into agreeing to a birth induction without knowing
risks, side effects, and alternatives to forcing the birth of their child.
Some doctors have also reported that some women have asked to force their
birth to get it over with or to coincide with a husband's schedule.
Gail J. Dahl, Executive Director of the Canadian Childbirth Association
says the group has worked diligently over the past four years toward
creating informed consent for this elective procedure in Alberta. The
Association highly recommends that the new guidelines also include new
research evidencing longer gestation time for first-time mothers, up to 42
weeks and longer. New research also shows that ultrasound tests used for
gestational dating have an error rating regardless of the trimester, with
the largest error rating to be shown in the last trimester.
Canada is not the safest country in the world in which to give birth, owing
in part to its high rate of induced birth, over 30% in some areas, which
often leads to unnecessary emergency cesareans.
Following is an excerpt of a letter from the Canadian Childbirth
Association director to Dr. Burns:
We believe this is a positive step forward in assuring safer childbirth in
the province of Alberta and we congratulate your Committee on Reproductive
Care and the Alberta Clinical Practice Guidelines Program for looking into
this critical area of informed consent on birth inductions.
The next step would be to create a sample informed consent for the
induction of labor which would include: risks to mother and baby, side
effects to mother and baby, alternatives, contraindications, (for instance
cytotec, which is increasingly used to induce birth, is stated by the
manufacturer to be contraindicated in pregnancy). Also appropriate warning
and precautions are shown in the patient inserts and the 1999 Canadian
Pharmacists Association Manual. I believe it is important to create this
sample of informed consent for birth induction as our Alberta physicians do
not have this information readily available for immediate use.
Your Guidelines need to state that gestation for a first-time mother is
longer, up to 42 weeks and longer and that accurate dating comes from the
first day of the last menstrual period. Ultrasound measurements in the
first, second and third trimester of birth carry an error rating on either
side of the date. Physicians using a forty-week due date for a first-time
mother and errors in gestational dating by ultrasound seem to be the cause
of untold numbers of premature babies being induced in Canada.
The increased cost to our healthcare and ever increasing health and birth
complications arising out of inducing premature babies in Alberta will
certainly decrease once your guidelines have been adjusted to include the
above points.
-Gail Dahl press release
Reprinted from Midwifery Today E-News (Vol 2 Issue 9 March 3, 2000)
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