Outcry Continues Over First-Baby-Born-in-Decade Derby : Birth: Are deadline deliveries unhealthy? Some experts say that, as a rule, babies should determine arrival time, not doctors or parents.


A decades-old tradition--the New Year's Day baby derby--was in full swing this Jan. 1, and as usual, parents, doctors and hospitals alike were working hard to win it.

In a Fountain Valley hospital, the clock ticked toward midnight as a 28-year-old woman tried mightily to push her baby into the world. But as her doctor eyed the clock, she was suddenly ordered to "hold it!" while a radio announcer counted down the final seconds of 1989--and only then was she once again told to "push!" At 20 seconds after midnight, 9-pound, 7-ounce Michelle Tran was born, briefly believed to be the first baby of 1990 for Orange and Los Angeles counties.

But wait: Five seconds earlier a 6-pound, 12-ounce girl was born in an Anaheim birthing center, delivered by a general practitioner who used forceps to pull the newborn out in an effort to deliver the first baby of the decade. He immediately tucked the baby in a Christmas stocking and rushed her next door to show her off to 4,000 people at the Melodyland religious service.

And at the same moment in Tarzana, a physician was in the middle of performing a Cesarean section that resulted in twin boys, one born a minute before midnight, the other a minute after.

There are prizes in this obstetrical version of "Beat the Clock"--publicity for obstetricians and their hospitals, celebrity status for the lucky infant and, for the parents, sometimes a shower of gifts ranging from diapers and infant formula to college scholarships.

But recently, medical leaders have criticized the "circus" atmosphere surrounding some of these births.

Joining them were medical ethicists, feminists and advocates of natural birthing methods who worry that tampering with the birth process--either by significantly slowing it down, speeding it up or scheduling a Cesarean section for convenience rather than medical necessity--could be risky.

Doctors note that deliveries scheduled primarily for convenience are still rare--and expressly forbidden by guidelines from the American College of Obstetrics and Gynecology. Also, after reading press accounts of this New Year's stroke-of-midnight births, many doctors said they did not believe most of the Jan. 1 deliveries in Southern California were particularly dangerous.

Still, the race for "the baby of the decade" produced widespread concern.

"I don't think we should take something as serious as the birth of a baby into a contest," said Dr. William G. Plested, a Santa Monica cardiovascular surgeon who is president of the California Medical Assn. "The primary interest of the physician should be the protection of his patients, both the mother and child."

Agreed University of Minnesota bioethicist Arthur Caplan, "Anything that is done for reasons other than the health of the patient is not consistent with good medical ethics."

Special Deliveries

It is risky to engage in practices that could lead to something worse, Caplan said.

" 'Let's push at 11:59' could lead to inducing labor at 10 so we get a delivery at 12:01," he said. "There's some danger that what starts out as cute or humanitarian might slide into getting competitive and dangerous."

Actually, the practice of scheduling deliveries for reasons beyond the medical ones is an old one, doctors and patients said.

They cited births that have been arranged to coincide with a doctor's office hours, a mother-to-be's "lucky day" or a father's desire to take a year-end tax deduction.

There is also a widespread suspicion, roundly denied by obstetricians, that timed births benefit doctors who have season tickets to sporting or theatrical events, said Jay Hathaway of Sherman Oaks, executive director of a national group promoting a child birth method called the Bradley Method.

But pregnant women--some of them quite prominent--have often demanded carefully timed deliveries themselves.

Marilyn Quayle, the vice president's wife, reportedly told her doctor to induce labor around the due date of her first child to ensure she would be able to take a scheduled bar exam. As a result, friends said, with her son newly delivered, the new mother took her exam seated gingerly on a rubber doughnut cushion.

England's Duchess of York, Sarah Ferguson, also had her baby early, reportedly because she was tired of being pregnant. Told that her labor probably would not start for three or four more days, the 28-year-old wife of Prince Andrew had her labor induced, delivering a 6-pound, 12-ounce baby Aug. 8, 1988--or 8/8/88--a date numerologists promptly declared as the luckiest in the century.

Induced labor for convenience came into vogue in the United States during the 1960s and early 1970s, experts on maternal health said, after the discovery that the drugs oxytocin and Pitocin could speed up labor.

During that era, one Philadelphia mother-to-be said she found herself an unwitting guinea pig for "speeded-up labor" 17 years ago when she entered a birthing center on Christmas Day to deliver her third son.

Deadline Pressure

The midwives "dearly wanted a Christmas baby" and despite her objections administered a drug to speed up her labor, said Nora Coffey, now director of the HERS Foundation, a support group for women with hysterectomies. As the drug took hold, "a bunch of midwives were standing beside me rooting and cheering for him to be born on Christmas Day."

Coffey said she really didn't care about the Christmas deadline but rather just "wanted to be left alone." Eventually, she got her wish. When her son was born about 18 minutes after midnight, the cheering squad was gone, for they had departed when she missed the cherished deadline.

The practice of inducing labor solely for convenience fell out of favor about 10 years ago as doctors discovered that it led to many unnecessarily premature births--and Cesarean sections. "This was before ultrasound was accurate, before people had good guidelines (for inducing labor)," said Dr. Thomas J. Garite, UCI's chief of obstetrics, "so people were inducing labor very haphazardly, and they paid the price."

About eight years ago, the American College of Obstetrics and Gynecology issued guidelines limiting "elective induction" of labor. In addition, said Dr. Edward J. Quilligan, a nationally known professor of obstetrics at UC Irvine, obstetricians are urged now to encourage women who have had a previous Cesarean to attempt to deliver their subsequent babies vaginally, rather than automatically scheduling them for another surgery.

Quilligan said his motto on delivering babies is a simple one: "Let the baby pick the time."

Still, he and other doctors said they saw nothing wrong with making slight changes in the timing of a birth--if the baby is mature and expected to be born at about that time anyway.

"You'll get mothers who want to deliver after midnight because it's the birthday of their husband or grandma is coming into town the next day," explained Garite. "If it's 11:45 at night and they want to wait 15 minutes, it's OK if it's done with good judgment."

Similarly, "if you were going to do a Cesarean for a very good reason and it wasn't super-emergent, it wouldn't matter if you did it at midnight" or waited 15 or 30 minutes, he said.

"It's like anything else in life. As long as you do it safely, it's fine. But if you get a little overzealous and let desires (for a timed birth) overwhelm your interest in safety, your good judgment, you're in trouble," Garite said.

One obstetrician explained that he once timed a delivery--but safely--so that his patient would deliver Orange County's first baby of the year. "This mom was dirt-poor," he said, "and we figured if she got the first baby, she'd get all these freebies--free formula and baby blankets" and more. It was "a spontaneous delivery. She just pushed at the right time," he said. "And we were two seconds after the hour."

Lately the "freebies" for the New Year's first child have slacked off in Orange County, doctors said. The Tran family of Long Beach for instance, got flowers, four weeks of diaper service, formula and a teddy bear. But elsewhere, such a baby is worth its weight in gold. In Boston, twin girls Jessica and Jennifer Rios, delivered at midnight and 12:01 a.m. at Brigham and Women's Hospital, received scholarships to Emmanuel College, a local women's college.

Such births are also great publicity for the lucky hospital, said Lauren Barnett, director of the Chicago-based American Society for Hospital Marketing and Public Relations. "It's usually a sure story for a hospital," she said.

"It probably doesn't hurt that Jan. 1 is not a heavy news day and there's usually space for that kind of story."

That was the case with the twins delivered in Tarzana.

Learning on New Year's Eve that their twins would be born around midnight, Valencia parents Glenn and Jill Iwamoto decided they prefered that each baby have a different birthday in a different decade. But it was strictly a coincidence that their wish materialized, insisted Dr. Allan Lichtman, the Tarzana obstetrician who performed the unscheduled Cesarean section.

Lichtman said he ordered a Cesarean section at 11 p.m. after Jill had labored unsuccessfully for 22 hours. "We realized it takes about 40 minutes to get things organized, get the anesthetic and the assistants, and we realized we would be delivering the babies close to midnight," he said.

He said the babies were healthy and that he knew he had about a 10-minute leeway for a safe delivery.

"The question came up--they would have birthdays together or possibly separately," he said. "I asked them to think about that issue."

Twins Span Decades

Lichtman said he did nothing to modify his medical practice based on the parents' preference. As it happened, Blair Michael Rikio Iwamoto was born at 11:59 p.m. and his brother Brooks Glenn Joji Iwamoto arrived at 12:01 a.m.

It was no Cesarean but a bit of painful persuasion that resulted in the birth of Michelle Tran 20 seconds after midnight, New Year's Day, at Fountain Valley Regional Hospital and Medical Center.

Obstetrician Co Pham said he reluctantly had to forgo a New Year's Eve party to rush to the hospital, where his patient, Khanh Quach, was in labor. Still, he said, "every year we do (this) for fun--all the hospitals calling each other about who has the first baby of the year. . . . We're not competing, just asking who has the first, for fun."

Meanwhile, Michelle's father, Long Beach store owner Joe Tran, said he and his wife really hadn't wanted to deliver the year's first baby. At five minutes to midnight when the baby was nearly out, "the doctor said, 'Hold it! You will have a delivery at New Year.' "

But at the time, his wife was "in very bad pain," Tran said, and she cried. "I said, 'She cannot hold it,' " Tran recounted, but "he (Pham) said, 'Tell your wife, breathe slowly, you can hold it.' " And despite her pain, she waited past midnight to give that final push, Tran said.

The delivery "hurt my wife," Tran said, but now that it is over, he has no complaints. "My baby is in very good health. We had a very good doctor."

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