[Paradigm shift in obsterics--the example of induction of labour]

Paradigm shift is moulded by the rapid advances in scientific knowledge, the results of evidence-based medicine and the guidelines and recommendations resulting therefrom as well as the continuous changes in medicine's social-cultural ambient. Features of a complex medical and social development are the declining number of births, a significant increase in the frequency of caesarean sections and an almost two-fold elevation of the number of induced births. This is especially valid for an overproportional rise in elective induction of labour which, today, represents the most frequently indicated intervention in obstetrics. The elective induction of labour in nulliparous women, however, is associated with an almost two-fold higher incidence of caesarean sections. It is clear for the example of induction of labour that today more than ever obstetric interventions are subject to a broad spectrum of paramedical as well as medical factors and are in fact influenced by them. These include, above all, the pregnant woman's right of self-determination and her individual needs, the logistics and infrastructure of the hospital, the concern about medico-legal disputes, and the increasing economic pressure. In this context the ever increasing competitive situation among the obstetric clinics plays a decisive role. Prerequisite for the induction of labour is an individual risk-use analysis that should be clearly and thoroughly explained to the patient and her partner in a personal conversation. The pregnant woman's frustration about a prolonged course of labour is a complication of the induction that must not be underestimated and leads more often than in the past to a secondary caesarean section. Recent publications warn of an increased maternal morbidity and perinatal mortality in cases of an induction of labour following a previous caesarean section. In contrast to the caesarean saving programme propagated in the 1990s, the historical postulate "once a caesarean always a caesarean" is experiencing an obvious renaissance. Irrespective of the non-medical and medical influencing factors, the obstetrician should not forget his / her own experience and intuition or confidence in his/her own abilities and pass obstetrics on to future generations as an individual art.