Do Inductions Really Rise Around the Holidays?
As long as I can remember in my doula career, I have been told, both seriously and sarcastically, that inductions rise around the holidays because doctors want to control the births they will have to deliver on..let’s say Thanksgiving day or Christmas Day.
I have to be honest in that I never really paid much attention to it because our team typically takes off the end of the year! It has been an intentional decision in years past to not take births in the months of December and January. This provided us with the time to disconnect, visit family and friends, and wrap up one year + dive into the next with a solid foundation. As you well know, 2020 has changed so much of what we knew and, for us, this meant not having the space to disconnect without leaving birthing people vulnerable in a global crisis and not traveling for this holidays. With this, we decided to work straight through 2020 into the start of 2021. And in this moment, the entire idea of ‘inductions increase at the holidays so doctors can be home with their families’ became utterly relevant.
So I did what I do best. I dove in head first.
Do inductions really increase when the holidays approach?
This is a map of the number of babies born on every single day of the year (2004-2014), see here. The darker the date, the more number of births. The lighter the date, the fewer number of births.
The first thing you notice is that the fall time is a hot time to have a baby with September being the overwhelmingly most popular month. This makes sense to me because the end of the year holidays (Christmas, Hanukkah, etc) are 9 months before that and people are getting jiggy with it during the holidays. The seasons impact our birth patterns and we have observed this within Tranquility by HeHe. I wrote about it here!
Next thing that we notice is that January through April is light. So I begin to look for the lightest and that turns out to be January. Calculating 9 months before that is April which doesn’t mean much. Tax season is stressful? Spring cleaning has people too tired? Allergies got you too stuffy? Eh. I wasn’t buying it. So I began to go the other way.
January, December, November. Well, well, well. Jackpot. This is what I had been warned about thousands of times before and it was unveiling itself right in front of my eyes. I could NOT believe what I was seeing. New Years Day, Christmas Day, and the day after Christmas (12/26) basically melted into the background indicating there were virtually no births occurring on those dates. How bizarre. New Years Eve and January 2 was a close second. I was floored.
As I continued to scan, I noticed that December 19 & 20 were a deep color indicating a ton of births occurred that day right in time to ensure they are discharged by Christmas--vaginal and c-sections so a provider might not even have to come in and do rounds. I continued on and, again, I noted a sequence of deep plum on December 28, 29, and 30 seemingly squeezing in births between holidays. Fascinating. I was hooked and had to look into this more!
Also, on this list of questionable birth patterns is July 4th! It’s the lightest shade of pink which says not a lot of births happen on this day.. Coincidence or intentional?
What do the numbers say?
So, let’s look at the hard numbers. (I rounded up in all scenarios since you can’t have .38 or .48 of a baby) If we take Christmas day, we see that 6,574 babies were born across the United States. It obviously won’t be an even split, but for the sake of this I divided the number of births by 50 (states) and that comes out to 132 births per state. That means that from Wyoming (state with the smallest population, 580K residents) to California (state with largest population, 39.51M--yes million) there are less than 150 births in each of these states--does that feel right to you? Does it feel like nature orchestrated that or human intervention? Check out the numbers for yourself here.
Let’s do a few more-- New Years Day has 7,792 births across our nation and that’s roughly 156 births per state. Christmas Eve has 8,069 births and that translates to roughly 162 births per state. The entire week of Thanksgiving is a light pink indicating not a lot of births are happening this week. One more and it’s July 4 with 8,796 births with means each state would have around 176 births. On all of these dates, we are talking about less than 200 births. To give you a reference point, there are between 33K-43K OB’s in our country with New York, California, Texas, Florida and Michigan having the most OB’s in comparison to the rest of the country.
Matter of fact, our country is experiencing a shortage in OB’s at the moment and it’s steadily declining. I like to think that we are shifting from highly medicalized birth to midwifery care and a more hands off approach. Time will tell.
They are human too. But you chose to be a doctor.
We must consider that doctors are humans, too. They want to be with their families on the holidays just like the rest of us, but then there’s a layer of, “but you chose to be a doctor.” We must remind ourselves how lucky we are to have servicemen and women, first responders, nurses, doctors and all other essential workers. However, this also opens the door for manipulation to have the chance to weasel its way in.
Our healthcare is broken.
If you missed one of our most recent Instagram posts (if you aren’t following us over there, you certainly should! It’s a fun time!), we shared about how money may be influencing the c-section rate in the US. A 2013 study found that the more educated someone was on the birth process, their options, and the medical system the less likely they were to have a c-section. This study looked specifically at physicians caring for other physicians and wouldn’t you know it—they perform SO MANY LESS c-sections on fellow physicians. They found that when the patient is another physician, they are less likely to end in a c-section. The authors suggested that since the patient (a fellow physician) is so educated on their options, the birth process, and the medical system, they are less likely to experience manipulative care that so often leads to unnecessary c-sections.
This study also shares an interesting fact that c-sections earns providers and facilities hundreds to thousands of additional dollars in revenue. So it makes sense why traditional CBE classes taught by hospitals are teaching people how to be compliant and not question the system. Yet, if you’re educated enough to know better, your odds of a c-section drastically decrease. I quickly recognized this critical flaw in our healthcare system years ago at the start of my birth work journey. I created The Birth Lounge to give pregnant folks unbiased, honest (not always pretty), transparent childbirth preparation.
You must advocate for yourself.
You still have so much control over your birth even if your due date is one of the dates we know tends to have few number of births. Be sure to do your homework on knowing how to advocate for yourself. Hire a our team to be with you--in-person or virtual doula support. Make a birth plan and discuss with your provider beforehand.
Here are a few resources that will be helpful to you in navigating this as you head into the holidays! First, knowing the research and science on inductions and c-sections is imperative. Here is a c-section bundle of resources that will help you understand how to avoid a c-section!
You may find that your provider tries to pull a fast one on ya in order to keep their holiday plans! Knowing the hard facts for yourself is the best way to ensure you will not be manipulated with false reasons--well, i’ll say reasons that are not evidence-based. The first one that comes to mind is The Arrive Study. This is the study that looked at whether inducing everyone at 39-weeks yielded better results. Some providers will try to use this study as a blanket statement, but there were big limitations to this study. You should read up on it before agreeing to be induced at 39-weeks--it’s not quite as simple as many providers might lead on. You can read the science here or listen to episode 147 of The Birth Lounge Podcast.
It’s also wise for you to know the science behind other reason that are *not* evidence-based reasons to be induced or have a c-section across the board: big baby, low amniotic fluid, due date, and advanced maternal age!
The Bottom Line:
You are in control. You get to call the shots here. The biggest and most powerful tool that you have in your toolbox is your knowledge. The more you are prepared for what to expect, the better you will be able to navigate these conversations and advocate for yourself.
“If you are due around the holidays, you should always question an induction or scheduled c-section.” -Dr. Sarah Leahy
If you want to learn more about how to have your dream birth, check out this free 30-minute masterclass, How to Craft Your Ideal Birth!