When the obstetrician looks at the clock – Kathimerini

«Why are you shouting like that? You're giving birth to your child!". The above resonant words still resonate –5.5 years later– in her ears. Afroditis Mitsopoulou"I was 40 weeks and one day pregnant." pregnant", firstborn, when my doctor insisted that I go to the maternity hospital to give birth," says to "K" the 45-year-old actress and director. “I didn’t agree and asked him to wait, but he was adamant.” Her doctor was one of the many obstetricians and gynecologists who choose to induce labor after the 39th week of pregnancy. In recent years, there has been a great increase in the application of methods for inducing labor.

In Great Britain, inductions from 20% in 2006 reached 33% in 2019, in Australia induction is performed at 39 weeks in over 40% of pregnancies, in Greece it is estimated, based on data from ELSTAT (ed. has data on this only from 2018), at 30%. We do not, however, have more data available on the medical history of pregnancies in Greece. "According to the literature, the reason why gynecologists make this decision is because after the 39th week there is a risk of endometrial death of the fetus, which is why in the last few weeks additional monitoring by the doctor and attention from all sides is required," comments a person in the field, "but, damn the lies, it is also done for practical reasons, when a doctor has about 40 women waiting to give birth in the same month, it is naturally impossible to give them their time."

The "hours"

The life and work rhythms of an obstetrician-gynecologist are too intense to synchronize with those of a normal birth – which most often begins at night. “Most gynecologists do the induction early in the morning, if within three hours they don’t have results, they put the woman in the operating room around 12 so that at noon they can leave for their office,” notes in "K" working in a maternity hospital.

“We often see the intensity with which two doctors can claim an operating room, in order not to change their schedule.” Moreover, in a sample analysis of medical records from 8,572 women who gave birth in a private health unit in Greece, it emerges that the lowest birth rates are observed on Monday, Saturday and Sunday. Also, the Greek authors of the study, which was published last August in International Journal of Women's Health, point out that “nursing women without a previous cesarean section […] are 73% more likely to give birth by cesarean section between 8.00 am and 3.59 pm compared to those who give birth between 12.00 and 07.59 am.”

58% of births in Greece are by cesarean section and 30% by the method of labor induction

In Ms. Mitsopoulou's case, the course of the procedure was traumatic for her and extremely detrimental to the health of the newborn, who had to be hospitalized for 20 days in the intensive care unit due to perinatal stress and the complications it caused in his body. The challenge causes unmanageable pain for Aphrodite, who then begs for an epidural. "It took a while for it to take effect, but the doctor didn't have time and immediately performed a vaginal examination, which was extremely painful and led to my 'water breaking'." The doctor and midwife, who were in a hurry because they had other events waiting for them, did not inform her of the steps or prepare her. "I was present, but it was as if they didn't see me," she says in the podcast, as well as in the experiential performance "Agoromana." "I tried to push it out without any results, I even agreed to the prospect of a cesarean section," she recalls, "but then they said among themselves jokingly, 'We'll get the new Chevrolet.'" Later, it becomes clear to her that they had christened the suction cup "Chevrolet." "When the baby came out, it was as if it was dead, but fortunately they brought it back immediately."

Mental trauma

Since Aphrodite decided to share her experience with the public, dozens of women have contacted her to tell her that they have experienced exactly the same thing. “I have even been approached by men after the performance, equally mentally traumatized by what happened to their partner and child,” says Ms. Mitsopoulou.

The risks

But why is it important for labor to start on its own? “When the process starts on its own, the body has created ideal conditions for both the mother and the baby and the possibility of a normal birth is high,” answers Ms. Koutoumanou, “the vital organs of the fetus and especially its lungs mature until the last moment.” Therefore, there are fewer complications during the newborn’s adaptation to extrauterine life. “The pulsatile secretion of natural oxytocin during the spontaneous onset of labor creates contractions and contributes to the strong bond between mother and child and should not be disturbed,” she adds. Inducing labor, according to her, involves a number of risks, such as fetal distress due to artificial contractions that cause alterations in heartbeats, risk of infection due to the many vaginal examinations, high levels of bleeding after childbirth, and great strain on the body, as artificial pains are more painful than natural ones.

For Ms. Koutoumanos, induction of labor is the best solution when there are confirmed medical reasons (gestational diabetes, high maternal blood pressure or residual intrauterine fetal growth), provided that the pregnancy has exceeded 42 weeks. She has studied and worked in Germany in the past and is convinced that if the role of midwives is strengthened and cooperation between doctors and midwives is cultivated, as is the case abroad, normal childbirth could be promoted in low-risk pregnancies. “The art of midwifery should not be forgotten,” she concludes. Obstetricians and gynecologists, who they speak to "K", point out that inducing labor in itself is not dangerous. "The issue, however, is how it is done and under what conditions," emphasizes the gynecologist – obstetrician Eleni Tzachrista. “The steps provided for in the protocol must be followed carefully and the woman in labor needs to have a two-day window available.” During this time, the pregnant woman should be able to be in the hospital, walk, eat, sleep, go to the toilet, etc. “This way, she is helped to have the necessary strength to push,” adds Ms. Tzachrista. In Greek hospitals, such a condition is unrealistic: the employees are few and without the appropriate training, the space is limited, and the birth is generally “medicalized.” “However, when we decide to induce labor, we must have patience and time to dedicate to the woman in labor,” she comments.

When is the safest method for mother and baby?

"Poorly executed provocations" are behind the high number of caesarean sections in Greece, according to the Dr. George – Konstantinos Papaioannou, obstetrician-gynecologist, specialist in fetal and maternal medicine and high-risk pregnancies. “Induction of labor has been targeted as a cause of an increase in cesarean sections, however, this is not the case; if done correctly, it contributes to a decrease in cesarean sections,” he replies. “In addition to induction performed for medical reasons of the mother or fetus, in recent years, induction of labor in uncomplicated pregnancies around 39 weeks of gestation has also been gaining ground, since recent literature highlights the safety of the procedure for the mother and the fetus,” he adds. The Royal College of Obstetricians and Gynaecologists and the National Institute of Clinical Excellence (NICE) of Great Britain recommend induction of labor in all uncomplicated pregnancies after 41 weeks.

The benefits concern both the baby and the mother. “Newborns born after induction at 39 weeks had less respiratory distress and a shorter length of stay in the neonatal unit,” says Dr. Papaioannou, citing some of the findings. For mothers, induction at 39 weeks has been shown to reduce the number of cesarean sections and the likelihood of hypertensive disorders of pregnancy. “A serious complication of vaginal birth is perineal trauma, serious perineal trauma is observed in about 1 in 20 women who have given birth vaginally,” explains Dr. Papaioannou. In a study of 1.5 million pregnancies, it was found that induction of labor at 39 weeks is associated with an approximately 37% reduction in the risk of maternal trauma during childbirth, as well as the likelihood of assisted delivery (suction and metal-assisted delivery). "It also confirmed the reduction in cesarean sections in primiparous pregnant women who undergo induction at 39 weeks compared to those who do not."

However, especially in our country, failed inductions are a common occurrence. “These are due to the non-use or incorrect use of prostaglandins to ripen the cervix, but also to the short period of time from the start of induction to the decision for a cesarean section, given that a successful induction usually lasts from 12 to 24 hours.” Among the factors that lead to failure, Dr. Papaioannou includes the immobilization of the pregnant woman and her lack of food, which exhausts her.