- Paul Shuen, a former surgeon and OB/GYN in Toronto, admitted to inducing labor in pregnant women without their consent in order to deliver their babies on weekends and to make more money.
- Shuen’s actions not only denied women control over their own bodies and babies, but also put them and their children at risk for serious and potentially fatal health complications.
- Labor induction is only supposed to be used when the woman or her baby’s health is at risk, and after doctors have conducted a special test.
- Risks of induced labor include a higher likelihood of cesarean delivery, a ruptured uterus, excessive vaginal bleeding, and a low fetal heart rate.
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When Lindsay Bruer, a nurse at Toronto’s North York General hospital, found small pieces of a white pill in a woman’s vagina during a routine exam in 2016, she and another nurse, Karen Yu, became suspicious, Toronto Life reported last week.
There was no record of the pill in the woman’s medical charts, so Bruer and Yu saved the pill’s remnants and decided to look into it. Later that year, lab reports found the pill was misoprostol, a drug that softens a woman’s cervix and causes contractions. It’s also used for the medical management of miscarriage, and one of two pills used for abortions.
That same year, Paul Shuen, who was then a well-respected surgeon and OB/GYN at the hospital, admitted something shocking: He’d given his pregnant patients misoprostol without their consent in order to induce labor. Shuen did this strategically so women he worked with would give birth on the weekends and he could bill the hospital more for the procedure, since weekday births cost less. Doing this also allowed him to schedule births so he could fit more into his day.
In 2018, Shuen paid $40,000 in fines for his actions, and his license to practice medicine in Ontario was revoked. Shuen also retired at that time.
Shuen's actions not only denied women control over their own bodies and babies, but also put them and their children at risk for serious and potentially fatal health complications, women's health experts say. "I can say that any clandestine attempt to induce women is reprehensible and malpractice," gynecologist Dr. Jen Gunter told INSIDER in an email.
Even when a woman consents to induced labor, the practice can come with serious health risks like excessive bleeding, uterine rupture, and lack of oxygen that can but both a mother and her child at risk for death.
Labor induction is supposed to be a last resort for expecting mothers
Labor induction is somewhat common, with an estimated 30% of women being successfully induced with consent.
The intervention can be medically appropriate if a woman is two weeks past her due date, her water breaks but labor doesn't begin, she has a uterine infection, or the baby stopped growing, according to the Mayo Clinic. Doctors might also recommend the method for expecting mothers with high blood pressure, kidney disease, or diabetes, since those conditions come with an increased risk of vaginal birth complications.
Misoprostol is just one generic drug that can be used for labor induction. Another is oxytocin, a hormone that also softens the cervix and causes it to contract. Doctors can also use a small hook to manually break a woman's water to start labor, according to the American Pregnancy Association.
But for most women, labor induction is neither necessary nor recommended. According to the Mayo Clinic, it's only supposed to be considered when the mother or child's health is at risk.
In some cases, women may request labor induction even if it's not medically necessary. For example, if a pregnant woman lives far from a hospital or has a history of quick labor, induction could be used to "plan" the delivery so a doctor can be present, the Mayo Clinic website noted.
Read more: 4 surprising facts about going into labor
But typically, labor induction for convenience purposes is frowned upon because of the complications that could arise. "It shouldn't be done for convenience. It should be done for a medical reason that has to do with maternal health or fetal health and should be discussed," certified nurse midwife Risa Klein told INSIDER.
Doctors are supposed to perform a special test before deciding whether to induce labor
Labor induction can affect individual women in different ways, and so doctors are supposed to screen women using a system called the Bishop score to decide if they're the right candidates for the procedure, Klein said.
"It will help you determine if her cervix is even favorable for induction, since not everyone is ripe for induction," she said.
To conduct the test, doctors measure how dilated a woman's cervix is, the thickness and consistency of it, its position, and where the baby's head is located. Based on these parameters, if a woman scores a 6 or higher, she is a candidate for induction.
It is unclear whether Shuen performed these tests before inducing labor in the women he worked with.
Foto: Doctors are supposed to screen women using a special test before considering labor induction.sourceShutterstock
Induced labor could require a C-section, lead to excessive bleeding, and lower a baby's heart rate
Induced labor can be risky in part because some studies show labor induction could increase a woman's chance of having a C-section, or when a woman gives birth through incisions in her stomach and uterus rather than vaginally. Although doctors aren't positive why this is, it could be because a woman's cervix may not be soft and flexible enough to vaginally deliver her baby.
While C-sections are sometimes necessary or even life-saving, they aren't desirable in otherwise normal and healthy childbirths because, as surgical procedures, they come with risks like infection, blood clots, and increased risks during future pregnancies, according to the Mayo Clinic. C-sections also increase the baby's risk of breathing problems or surgical injury.
Read more: How your fertility changes throughout the years
Another risk of induced labor is a slowed heart rate for the baby, since some induction medications cause increased contractions that lessen the amount of oxygen that reaches the baby, according to the Journal of Midwifery and Women's Health.
Induction can also increase the risk of other labor interventions and the baby's use of NICU care, according to the California Health Care Foundation.
There are non-medical ways to try to induce labor
If a woman reaches her due date, there are ways to encourage labor without using medication. An expecting mother could, for example, stimulate her own nipples with a breast pump or her hands, or a doctor could sweep her cervical membranes during a vaginal exam, according to the Journal of Midwifery and Women's Health.
These options won't guarantee labor induction, but they may be safer than using a labor induction medication.
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