As inductions went up, so did C-sections.

I am a reality show watcher. I love E!, especially. The shows are so bad that they are good. My husband and I (okay, I) love yelling at the screen when people do really stupid things. But over the holidays, I was doing more than yelling. I actually started to cry. The show: Kendra, the spin-off of The Girls Next Door. The problem: they induced her a little early, resulting in a C-section. The entire time I was watching, I was telling at the screen: “Don’t do it! Inductions rarely work! You’re going to end up with a C-section.” Which is exactly what happened.

I’ve written about this before. According to the National Vital Statistics Report by the U.S. Department of Health & Human Services, the rate of inductions more than doubled over the past 20 years. It was 9.5 percent in 1990. It was 22.3 percent in 2006. I’ve also recounted the stats that The March of Dimes is trying to get out there: that babies shouldn’t come out until they are ready. Late preterm infants (babies born between 34 and 37 weeks) are:

• 6 times more likely than full-term infants to die in the first week of life (2.8 per 1,000 vs. 0.5 per 1,000)
• 3 times more likely to die in the first year of life (7.9 per 1,000 vs. 2.4 per 1,000)
• Often weigh between 4½ and 6 pounds, and they may appear thinner than full-term babies.
• Remain at higher risk than full-term babies for newborn health problems, including breathing and feeding problems, difficulties regulating body temperature, and jaundice
• More than three times as likely to develop cerebral palsy and are slightly more likely to have developmental delays than babies born full term.

But doctors continue to do scheduled inductions and, when those inductions fail, C-sections at 37 weeks. Some just skip the induction entirely and do the C-section from the start at 37, 38, 39 weeks. (And The March of Dimes and researchers says 38 and 39 weekers aren’t a good idea, either. Check out this great March of Dimes feature: Why The Last Weeks Count.)

Right now I’ve got a friend who is pregnant. She was due on January 7. She had a C-section with her first baby. Now she’s trying for a vaginal birth after cesarean (VBAC). Amazingly, her doctor is letting her go one week post-date. He knows that most first-time moms are a little late. (And since she never delivered vaginally, as far as her cervix is concerned she’s a first time mom.) I am so impressed with that doctor and with my friend. She’s been done for a while. She’s got a 19-month-old, and running around after him tires her out. But she wants to have a third baby, and she doesn’t want to take on all the risks that a second and third C-section entails. So she’s waiting. And the doctor isn’t pressuring her or pushing her.

I wish Kendra Wilkinson’s doctor was as kind. I wish he let her body do what it needed to do. Yes, her baby was large, but that doesn’t mean she wouldn’t have been able to deliver him. Or maybe he would have been one of the 15 percent of people who the World Health Organization expects will have C-sections. (Yes, that’s right. The WHO recommends that countries set a goal of a 15 percent C-section rate. Sort of stinks that, right now, the U.S. rate is 31 percent.) But she’ll never know, will she? In the meantime, if you’re reading this please think good thoughts for my friend. She’s only got 24 hours before her scheduled C-section.

Are you a mom? How did you deliver your baby? Did you have a choice? Did you ever feel pressure to do one thing over the other? Talk about it below.

Being born is hard enough. We need to give our babies the best chance possible.

I’ve written about it before: Both my kids were a week late. And both times my midwives and the doctors they worked with were pressuring me to induce. (Well, the second midwife not-so-much, but she did say she had to induce if I went past that weekend.) One high risk doctor told me he would have induced Keira, my youngest, at 37 weeks. If he had, she would have been classified a late preterm birth, one of a growing category of preterm babies here in the U.S.

You might not think a baby born at 37 weeks would be considered preterm, but it is. And unfortunately, even late preterm babies are at risk for a host of problems, according to the March of Dimes. Late preterm babies are:

• 6 times more likely than full-term infants to die in the first week of life (2.8 per 1,000 vs. 0.5 per 1,000)
• 3 times more likely to die in the first year of life (7.9 per 1,000 vs. 2.4 per 1,000)
• Often weigh between 4½ and 6 pounds, and they may appear thinner than full-term babies.
• Remain at higher risk than full-term babies for newborn health problems, including breathing and feeding problems, difficulties regulating body temperature, and jaundice
• More than three times as likely to develop cerebral palsy and are slightly more likely to have developmental delays than babies born full term.

That’s why, while it’s easy to be tempted into letting a doctor or midwife induce, it may not be in the best interest of moms or babies.

November is Premature Awareness Month. Want to learn more about why you should hold off whenever possible with artificial inductions? Here’s a quick Q&A with Janie Wilson, MS, RN, Women & Newborns Director of Nursing Operations at Intermountain Healthcare in Salt Lake City, Utah, a not-for-profit hospital system that is responsible for delivering 53 percent of all babies in that state. Recently, the organization implemented a program to reduce unnecessarily early labor inductions with amazing success.

KB: Why are so many women delivering via induction today?

JW: It’s a combination of doctors and women. Women don’t want to be pregnant anymore after 36 or 37 weeks. Meanwhile, if a doctor selectively induces you on Thursday morning, he or she won’t be at the hospital at 2 a.m. on a Saturday night.

KB: What’s the risk of inducing before 39 weeks?

JW: We, as a country, are electively inducing women at 39 weeks when their cervix isn’t ripened. But if you do this, those same women may have a long, protracted labor, along with an increased risk of C-section and morbidity.

KB: What has your hospital done about this?

JW: We’ve got a guideline that says we do not electively induce a first-time mom until they pass the 39-week mark and have a Bishop’s score of 10 out of 13. This score takes into account five components of a vaginal exam: cervical dilation, effacement, consistency, and position along with fetal station — how far down the baby’s head is. We require both because due dates are just an estimate.

KB: What would you tell an expectant mom who is consider induction — whether it’s coming from her or her doctor?

JW: Some women will go wherever the provider will lead them. But this is not like scheduling your nail appointment. You have to make your own decisions. There are associated risks and costs that go along with inducing early. If you wait until your body is actually ready to deliver you will generally have a much better outcome.

Just look at what we’ve accomplished. Since 1999, our percentage of all inductions before 39 weeks has dropped significantly, from approximately 28 percent to only 3.4 percent. We’ve also seen a 90-minute drop in the average length of labor in electively induced patients, with fewer emergency cesarean sections and other medical complications associated with deliveries. Our average length of stay has dropped three hours. Today, our primary C-section rate (the rate of first time moms) is almost zero. We have really changed our culture for the better. Women should demand the same outcomes for their own births.

The March of Dimes this week released its Premature Birth Report cards. Alarmingly, the majority of states received an F; not a single state got an A. One state — Vermont — got a B. To learn more about prematurity, or to get involved with changing this dangerous paradigm, join the March of Dime’s National Advocacy Network by clicking here.

Another healthy baby delivered by a midwife.

“I wish you would go to a real doctor.” We were standing in the kitchen. My mom had only found out I was pregnant a few days prior, and she was already haranguing me about my choices.

When I had Katelyn, I had a midwife. I also had a mental block—and an 8 pound, 5 ounce baby with a giant head– so while my labor was pain-free my birth experience was not what anyone would wish for. I was sore and bruised for weeks. I was anemic after losing so much blood. I looked like hell. I know she blamed my midwife.

This time, she had more to worry about. I had a midwife—someone new– but I also had a high risk pregnancy, and my mother was afraid that I would literally die because a doctor wouldn’t be the one catching the baby. She didn’t understand that my midwife, who I absolutely adore, was working hand-in-hand with several doctors the entire time making sure I had the best care possible. In fact, she made my pregnancy, labor, and delivery even better than it could have been if a doctor delivered Keira.

My midwife let me deliver at 41 weeks–Katelyn was a 41-weeker, too–all the while carefully monitoring me and the baby. (Although she told me on Friday, the day before I delivered, that if I wasn’t in labor by Monday she was going to induce.) Meanwhile, my high-risk specialist had been pushing for induction at 37 weeks. To this day I truly believe that my midwife’s simple trust in me and the process helped me avoid a C-section and a small baby since Keira was only 7 pounds, 3 ounces when she was born. She also fought to get me into a birthing room, and helped me have a delivery that I look back on with nothing but pride.

Still, my mom, like most other people, didn’t know what a midwife does—or even what a midwife actually is. If she had maybe she would have been a little more confident about my choices.

Do you know what a midwife does? Here are five facts that I wish everyone knew about midwifery.

1) A certified midwife (CNM) goes through a rigorous training program, which includes a hands-on internship.

A CNM is an advanced practice nurse. She must first attain a nursing license, which is a B.A. or a B.S. in nursing, and then undergo what is essentially a master’s program in midwifery. Once she completes the program, she must take a national certifying examination administered by the American Midwifery Certification Board (AMCB) to become a CNM. The program is unique because CNM candidates spend time interning—much like a doctor would—with other CNMs.

2) Midwives can—and do—spend more time with their patients.

“We do what doctors can’t,” says Jane Crawford Peterson, CPM/LM, who runs a midwifery practice called In the Beginning based in Iola, Wis. “We spend long periods of time at prenatal visits, which means we can hold a woman’s entire story. Our prenatal visits are often scheduled for an hour, so we talk not only about how the baby is doing, but what the woman does throughout the day. We can understand her goals for her birth. It’s not just about taking blood pressure. Clinical signs can be ascertained in 15 minutes. We’re focusing on more than just physical health.”

I know one of the things I loved about having a midwife was—unlike my friends who labored with a random labor nurse they had just met—she was prepared to stay with me the entire time I was in labor. I like to be alone during labor, so she went off to sleep for a bit, but she was the one who checked my progress. And she was there the entire time I was pushing. She was also the one who delivered my baby. Plus I knew there wouldn’t be any bait and switch nonsense going on. The person who gave me my prenatal care was the person who delivered my babies, unlike many of my friends who had to take whichever doctor happened to be on call when they went into labor.

3) Midwives have a lower rate of Cesarean sections.

It may be because doctors don’t think C-sections are a big deal—a recent study found that “sixty-five percent of midwives considered the rates of cesarean section in their hospitals to be too high compared with 34 percent of obstetricians.”  Or maybe it’s because doctors induce labor far more often than midwives, or that they are more likely to prescribe epidurals. Whatever the reason, fewer women cared for by midwives have C-sections.

4) Midwives respect and work with doctors—and most doctors respect them, too.

“I have 18 physicians who I routinely consult with. I stand firmly in liking the fact that I hold hands with physicians so that smooth transitions can occur in the event that something unexpected pops up during the pregnancy or birth,” says Crawford Peterson. (And as crunchy-granola as I am, I wouldn’t work with a midwife who didn’t have this type of arrangement.)

5) Midwives can do everything a doctor can except prescribing medicine and ultrasounds and doing operations.

When I ripped giving birth to Katelyn my midwife was the one who sutured me up. Prenatally, she did all my exams. She looked at my lab work. She did my postpartum exams. I felt taken care of, respected, and heard. It was a wonderful thing. Plus, since she works directly with a group of wonderful doctors I knew that, in the event of an emergency, I was in great hands no matter what.