“Honey, I think it’s time,” she says.

Her rumpled husband rushes around, grabbing suitcases, helping his pregnant wife to the car and racing to the hospital.

What could be a scene from a classic sitcom is becoming an exception to the rule in the U.S.

Induced labor and Caesarean section deliveries account for almost half of live-birth deliveries in 2003, the latest year reported by the Centers for Disease Control and Prevention.

A growing number of parents are choosing to schedule their baby’s arrival.

Studies show 33 percent to 40 percent of induced labor births are elective, or not medically necessary.

“We get more and more requests,” Dr. Richard McKinley said at his Budfield Street office.

The prominent obstetrician-gynecologist says typical patients are working women who like to plan ahead and schedule important events in their lives. They need to schedule maternity leave, arrange care for older siblings and let their husbands know when to ask for time off.

“They work full time,” McKinley said. “Their husbands work. They are both ready to go. They set it up for 10 o’clock Tuesday morning, drop the kids off and come in. It was convenient for everybody.”

If the mother meets all the recommended medical criteria, McKinley said, there is little increased risk of complications in a scheduled delivery.

“We are medically able to respond to crises better from 7 a.m. to 1 p.m.,” McKinley said. “You have a fully-staffed hospital.”

Some disagree.

“I don’t think that is always the case,” said Jeannette Crenshaw, president-elect of Lamaze International. “I think most hospitals are prepared to handle emergencies 24 hours a day.”

Lamaze believes healthy babies of healthy mothers should arrive on their own schedule.

“There is no magic time when all babies are ready to be out of the uterus,” Crenshaw said. “The best outcomes are when labor begins on its own.”

Doctors and mothers can’t determine due dates with 100 per-cent accuracy, she said. That means inducing a mother one week before her estimated due date can bring a baby into the world three or more weeks early.

Not so, says Dr. Abid Khouzami, a Johnstown ob-gyn.

With early prenatal care, doctors can pinpoint a due date within a week, he said, and while normal pregnancies are considered to be 40 weeks long, babies are considered full term after 38 weeks.

“There is no (increased) risk to the baby or the mother – if conditions are favorable to induction – anytime after 39 weeks,” Khouzami said.

Dr. Pradeep Kulkarni of Windber says the region’s high number of military families has brought some requests for scheduled induction because of limited leave for deployed troops.

If the doctor follows criteria, Kulkarni sees no harm with planning delivery dates.

“With induced labor, the success is as good as natural labor would be,” Kulkarni said.

Crenshaw admits proper, early testing can narrow due dates to within a week, but she wonders how many pregnant women get those early tests. Health risks increase when the baby is near term, or less than 37 weeks old.

The American College of Obstetricians and Gynecologists has no official position on elective induction but has established criteria it says keep health risks at a minimum.

Khouzami and McKinley said they strictly follow those criteria, which require reliable tests of due dates or lab tests showing the baby’s maturity.

There also are criteria for the mother’s condition.

“You are not going to schedule somebody until you are sure they are ready,” Khouzami said.

“If you stick to your criteria, it works,” McKinley said. “There’s a line here you can’t cross. It can’t be. You have to wait.”

All three doctors are scheduling more elective inductions.

“There are two sides to it,” Kulkarni said. “The patients are demanding it and, in part, there may be physicians’ convenience involved, but to less extent.”

Local ob-gyn practices provide their own backup coverage around the clock, Khouzami said, so there is little reason for doctors to worry about the arrival date or time.

“We don’t plan for a weekend off,” Khouzami said.

Another baby-delivery trend, the hotly debated elective Caesarean section, still is a rarity in the area, doctors said.

“We get very few requests,” McKinley said.

In both cases, ethics standards require doctors to outline all risks of elective delivery methods. The decision belongs to the patient, McKinley said.

In one case, a patient’s memories of a relative who died in childbirth left her mortally afraid of labor. She told McKinley the only way she’d consider having children was if she could go Caesarean.

“I said, if that’s the only thing keeping you from having a baby, we can fix that,” McKinley said.



Stork’s path



Types of delivery in the United States, 2003:



Total live births: 4,089,950.



Caesarean: 1,124,736 (27.5 percent).



Labor: 2,965,214 (72.5 percent).



Natural labor: 2,122,684 (51.9 percent of all births).



Induced labor: 842,530 (20.6 percent of all births).



Source: National Vital Statistics Report, Centers for Disease Control and Prevention.

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