Image by Michael Bentley
One of the most common procedures today is labor induction. Many women today choose to induce labor or end up with labor augmentation for “failure to progress.” Most of these inductions are not medically necessary. Since induction can come with serious risks, it’s important to choose it only when the benefits of inducing labor outweigh the risks.
Should Women Induce Labor?
There are certainly times when a woman does need to induce labor. These may include:
- The mother has developed pre-eclampsia
- The mother has developed cholestasis in pregnancy (liver issues)
- The baby is showing signs of distress (lack of movement, heart rate decels)
- There is another immediate concern with the mother or baby’s health
In these situations, which should be carefully evaluated by an OB, inducing labor may be the safest course of action. When the baby or the mother’s health is in danger, sometimes getting the baby out as quickly as possible is the best way to ensure the health of both.
When Shouldn’t Women Induce Labor?
While the reasons above are very valid reasons to induce labor, most reasons that women are given today are not medically necessary. Let’s take a look at some of these common reasons.
You Have Reached or Exceeded Your Due Date
As we talked about in the due date post, your due date may or may not even be accurate. Some babies need longer to grow and develop than others do. Simply reaching an arbitrary date is not a reason to induce labor, if mother and baby are doing well. If mom is feeling well, does not have high blood pressure, does not have glucose or protein in her urine, does not have any (or minimal) swelling in her legs, and baby’s active with a strong heart rate, there is no need to induce. This is the most common reason given, but in and of itself, it is not a medical reason to induce labor.
Your Baby Might Be Big
Ultrasound and other measurements prior to birth are accurate within about 2 lbs. Which means if they say “Your baby is going to weigh 9 lbs.,” your baby may weigh anywhere between 7 and 11 lbs. These measurements, in other words, are highly inaccurate. Also, unless the mother has gestational diabetes or some health condition that could cause problems with the baby’s development, weight, or mother’s ability to labor, bigger babies are not necessarily harder to deliver. In a healthy mother, her body will not grow babies bigger than she can safely deliver, if she is allowed to labor and deliver at her own pace.
When a mother goes into labor on her own, her body goes through some final changes that allow her ligaments to relax more, meaning she’s more able to stretch to deliver the baby. Birth positions can also affect mom’s ability to stretch and open. Women who are induced do not have the benefit of these extra hormones and often end up in less helpful birthing positions.
(And as a small note of interest, two days before my third baby was born, I knew that he could not grow any bigger and would have to come out. I couldn’t even use the bathroom easily anymore because he was squashing my bladder completely. I had never felt so full of baby with my other two. He was born at 8 lbs. 11 oz., a full 1.5 lbs. bigger than my other two. Still, I pushed for only a couple of minutes and barely tore, so I had no issues.)
Tired of Being Pregnant
Pregnancy is wonderful, but that doesn’t mean every moment is easy. Your body is stretched to its limits and you’re probably sore in your hips, back, and all kinds of other places. You probably are not sleeping well. Everything is more difficult when you are that pregnant. (A good chiropractor can help with some of that pain and the sleeping difficulties, though.)
Some well-meaning doctors will suggest inducing around 38 or 39 weeks because of this discomfort. If these discomforts are normal pregnancy-related things, then inducing is not the right solution. (Try warm baths, massage, a chiropractor, rest, light exercise, etc. instead.) If these discomforts are actually above and beyond, and indicative of a problem, see above: an induction may be necessary. For most women, though, the discomforts are just that. And remember, they’ll go away very soon after your baby is born! This time is short. Treasure the last few days or weeks of your baby moving within you, and give yourself permission to move at a slower pace. The longer babies stay inside (assuming good health for the mother and baby), the better.
Some women who are trying for a VBAC (Vaginal Birth After Cesearean) are told that they should be induced. This is usually so they are in a hospital for monitoring during their labor, just in case anything goes wrong and a repeat c-section is needed. However, the use of Pitocin in women with a previous c-section actually increases the likelihood of uterine rupture!
Convenience of the Doctor
This is the worst possible reason to induce, ever. It does not matter if your doctor is going on vacation next week when you will be 39 weeks pregnant, if your doctor has special clinic hours that he must get to, or if your doctor prefers not to be called away from home at 1 AM on a Saturday morning or because it’s a holiday. (If you don’t want to work odd hours, don’t work with pregnant women!)
It does not matter if your doctor is “available” for the birth or not. Most doctors are not there throughout labor anyway, they just show up to catch. Any doctor can do that. Rushing your baby or your body is not necessary or healthy.
I’m sure some of you are going to get upset with me for this, but personal convenience is also not a reason to induce labor. Some women want to ensure than their husbands can be off work, or their parents can be in town. In the vast majority of these cases, arrangements can be made so that things work out okay without having to schedule an induction for a non-medical reason. (I even know one woman who flew a photographer friend in from California — she lives in Ohio — to be there for her birth. She did not induce and the baby’s own timing worked out perfectly and the photographer was there!)
The reason personal convenience is not a reason to induce is because induction comes with serious risks. Those risks are typically not worth any convenience that may be gained by scheduling baby’s birthday in advance.
What are the Risks of Induction?
Sadly, downplaying the risks of induction are common, with the lack of being informed. Everything is a risk-benefit analysis, and while, in the cases of maternal or fetal distress, the need to get the baby out will probably outweigh any of these risks, in “convenience” circumstances they likely will not.
- Low heart rate/diminished oxygen supply to the baby
- Very strong/unmanageable contractions
- Premature birth (if dates are suspect)
- Breathing problems in the baby after birth (in a spontaneous labor, there are chemical changes that occur that finish maturing the lungs in the hours prior to labor)
- Cord prolapse
- Use of vacuum and/or forceps
- Prolonged labor
- Uterine rupture
- Increased likelihood of learning disabilities in babies born prior to 39 weeks
- Constant fetal monitoring/unable to move around
These are very serious risks. Inductions often lead to a cascade of interventions. A C-section is common due to women’s bodyies not being “ready”. C-sections are another topic entirely, of course.
When thinking about induction, your doctor should discuss all of these risks with you, as well as any potential benefit in your situation. Consider making a choice on what will be safest and healthiest for you and your baby.
While we are not here to judge women based on the choices they make in pregnancy and birth, we do strongly believe that women need to have all the information before making a choice. It is not a real ‘choice’ to induce labor if you are unaware of the associated risks. If you are aware and feel comfortable assuming those risks, whatever the reason for choosing induction — then that is your choice.