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Inducing at 39 weeks: Washington Post story mystifies more than clarifies

Rating

3 Star

Tags

Should pregnant women be induced at 39 weeks?

Our Review Summary

Lady in HospitalThis is a story about whether pregnant women should have labor induced once they reach 39 weeks.

But, the issue is discussed in a confusing way, with the bulk of the story dedicated to statements from a debate on the issue at a recent medical conference. There’s also a strong “he said, she said” undertone: Except for one brief quote, the proponents of inducing at 39 weeks are men and the advocates of waiting longer are women.

Unfortunately, readers are not given any solid grounds to evaluate the competing positions, just vague conflicting claims that ping-pong through the story. The question posed by this story has been studied and considered for many years, and so readers deserve more than a story that just tosses equal portions of opposing arguments at them without providing hard numbers about possible benefits and harms–or any clear sense about the quality of the evidence deployed by each side in the debate.

 

Why This Matters

A change in clinical practice regarding when to induce labor could affect as many as 3 million pregnancies a year in the United States.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

There is no discussion of the cost of elective induction of labor or how it compares to waiting longer for labor to begin on its own.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story quotes advocates of inducing labor at 39 weeks as saying it might lead to fewer Caesarean deliveries and might reduce complications, but no numbers are provided. The story also quotes an advocate as saying the risk of stillbirth and neurological injuries rises after 39 weeks.

Not only are no numbers cited, there is also no mention of any evidence that inducing labor would change the long-term outcomes for those babies; that is, what if inducing labor earlier prevented a stillbirth, but that baby had underlying problems that lead to death soon after birth? These important questions about how to weigh any potential benefit of inducing labor earlier are not addressed in the story.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

The story quotes several opponents of earlier induced labor, who refer to risks including “decreased blood flow and oxygen to the baby,” detached placenta and uterine wall tearing.

While these harms are outlined in only vague and general terms, without specific numbers or citations, this at least acknowledges harms, so we’ll rate as Satisfactory.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

Evidence for or against inducing labor earlier is mentioned in only general terms. There is allusion to “recent studies” but no sense of their design or quality.

Near the end, the story does state that the American College of Obstetricians and Gynecologists (ACOG), which staged this session at its conference, has not changed its position, but the story leaves readers to decide on their own whether that means the ACOG’s position is more reliable than the pronouncements of two doctors or that the organization is just a stodgy bureaucracy.

Does the story commit disease-mongering?

Satisfactory

This rating is a close call, because the underlying premise of the story is that some experts think that, after 39 weeks, normal pregnancy should be considered a problem requiring treatment. Such a position would shift the overwhelming majority of expectant mothers from “normal” to “at risk.”

Nevertheless, we will rate the story Satisfactory on this criterion because it includes several vocal opponents of any change in the prevailing definition of the healthy length of pregnancy.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

As noted above, the story includes several sources who criticize the proposition that labor should be induced earlier routinely. The story also quotes an opponent who charges that obstetricians have a philosophical bias in favor of medical intervention, which in a way flags a potential conflict of interest for readers.

Does the story compare the new approach with existing alternatives?

Satisfactory

We will give the story a Satisfactory rating on this criterion because it clearly spells out that the subject is a debate between inducing labor 39 weeks into a normal pregnancy or waiting longer. However, the story mentions only one method of inducing labor.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

Since the discussion centers on when to induce labor, it is clear that treatments to induce labor are widely available.

Does the story establish the true novelty of the approach?

Not Satisfactory

The story refers to recent studies, but again there are no details provided, so readers are not told what “recent” means. Have the studies been around for years, but just escaped the notice of the featured physicians until they checked the literature in order to prepare for their panel session? Or is there really some important new evidence that wasn’t available when ACOG and other groups issued the latest version of their recommendations about inducing labor? The story doesn’t answer those questions.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story published on June 27, 2016 refers to a session at a conference that occurred in May. It is not clear whether the reporter attended the meeting and spoke to the participants or merely relied on second-hand reports of the session. However, the story includes quotes from what appear to be interviews with several sources.

Total Score: 6 of 10 Satisfactory

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