Should you try to induce labor or avoid labor induction? Everyone has a different opinion: your physician, your childbirth educator, your mother-in-law - even the mailman.
What Is Labor Induction
Labor induction occurs when contractions are stimulated by something other than the mother's natural hormones to initiate labor. There are a number of different reasons this may be done.
The rate of labor induction has risen significantly in the last decade: with 40% of women reporting their physicians suggested inducing labor.
Inductions are usually done at the local hospital. A number of different procedures can be done to induce labor.
In addition to medical inductions, some women decide themselves they wish to initiate labor. Self-inductions are done by a variety of means - with differing rates of effectiveness and safety.
Before anyone decides their labor should be induced, whether by themselves or their doctor or midwife, they should have an idea of the risks and benefits of induction.
Benefits of Labor Induction
Reasons to Consider Inducing Labor
"Are you crazy," someone asked me. "Is there any woman out there who wouldn't want their labor induced?"
Well, actually, there are many mothers who want to avoid labor induction, but the point of this speaker was that so many women want to "get it over with." The aches and pains of pregnancy, difficulty finding a comfortable position to sleep in, pelvic pressure, and a desire to have the pregnancy done once and for all cause many women to enthusiastically agree that an induction is a good idea.
The Baby's Condition
One of the most valuable reasons for inducing labor, is to delivery a baby whose placenta is not working well. In cases of IUGR (intra uterine growth restriction), still birth or injury to the baby can result if their is less blood flow through the placenta.
There are other conditions that might also lead to induction: low level of amniotic fluid, poor glucose control with diabetes, history of stillbirth for no known cause.
In these situations, physicians often recommend inducing labor while the baby is still healthy, for fear of having a poorer outcome if pregnancy continues.
A common reason for induction is the estimated fetal size. Often inductions are done with a large baby, to prevent a cesarean later if the baby is too large to fit in the pelvis. In addition, ACOG recommends inducing babies over 4500 grams (10 pounds) to prevent shoulder dystocia. Shoulder dystocia occurs when a baby's shoulders get stuck after the head is born.
Placentas loose some of their function about two weeks after the due date. It is common is some hospitals to schedule inductions for two weeks after the due date when the baby is "post dates."
Some practices schedule the induction one week after the due date. This allows a margin of error for estimating the due date, as well as a period of time to allow the labor to start. Deliveries don't always occur the day the induction is scheduled. They can take several days, and they can get postphoned when the hospital is busy. Therefore, many begin scheduling inductions one week after the due date.
Inducing labor is convenient - for the family, for the physician, for the hospital.
While social inductions are often frowned on, they are nonetheless widely practiced. Labors are induced before the doctor's vacation, while mom is visiting from out of town, before holidays, and for many other reasons.
Risks of Labor Induction
Reasons to Avoid Labor Induction Well, if it's so convenient, gets the show on the road, and lets us hold our baby sooner, why not induce every labor?
There are a number of risks to inducing labor as well as benefits.
One of the most common problems is the delivery of a baby whose lungs are not ready to the important work of breathing.
About 12% of babies in this country are born premature, before 37 weeks. Fortunately, the majority of those babies do just fine. This has led many to feel that it is safe to induce at 36 weeks.
For many years, the American Academy of Pediatrics has warned that labor should not be induced before 39 weeks because of the risks of respiratory distress in babies. Yes, most babies at 36 weeks are fine, but some babies at 38 weeks are not. Thousands of babies every year are sent to the NICU at 37 or 38 weeks.
After years of research demonstrating unacceptable risks to babies, ACOG has made their guidelines even stricter. It is now considered malpractice to induce labor before 39 weeks "just in case." The only acceptable is not acceptable to avoid labor induction before 39 weeks is if fetal testing demonstrates the baby's condition is compromised.
When the uterus contracts, blood flow to the baby is diminshed. In some cases, the contractions that are stimulated by an induction may cause fetal distress because of the decrease in oxygen. This is usually followed by a cesarean to prevent injury or death to the baby.
This is a fancy way of saying the uterus is contracting too much. This leads to fetal distress, described above. With some methods of labor induction, the medication can be stopped and more time given for labor to ensue naturally. Other methods of labor induction may not have the option of stopping.
The stronger and more intense contractions caused by IV pitocin not only can cause fetal distress through tachysystole, they also increase the amount of pain the woman experiences. With spontaneous onset of labor, contractions start mild and gradually build up, allowing a woman to develop a rhythm and work with her body.
With pitocin induction, contractions start strong, and the medication is increased at a fairly quick rate. The goal is usually to have contractions in an active labor pattern within an hour or two of starting the induction. Natural contractions are milder and increase in intensity more slowly.
High Rate of Cesarean
Many practitioners are not always upfront with their patients that inducing labor significantly increases the chance of cesarean delivery. Usually about 50% of inductions are not successful. Once an induction is started, it leads either to the birth of the baby by vaginal delivery or cesarean delivery within a set time frame. Since some women's bodies were not physiologically ready for labor, a high percent do not give birth within a day and the baby is born by cesarean.
Parents should realize with medical induction they have about a 50/50 chance of cesarean. In many instances, the baby's condition warrants that risk. However, considering the risks inherent with abdominal surgery, this is a good reason to avoid labor induction if not medically necessary.
Prevents Physiologic Labor
When labor is induced with IV pitocin, the labor is controlled by external means. This does not allow the woman to tune in to her body's natural signals and work with her body in a physiologic labor.
The pitocin-enhanced contractions are far more intense than natural labor contractions, and the majority of women need pain medication to cope with them. The percentage of women who avoid pain medication is much lower when labor is induced. For those who wanted to labor naturally, this is common reason for wanting to avoid labor induction.
Decreased Breastfeeding Success
Babies who have been induced have a lower rate of breastfeeding success. There are no good, solid research studies that can demonstrate the exact mechanism. Breastfeeding has been proven to be hindered by the following:
Increased pain during labor
Increased pain after labor
Separation of mother and baby
All of these occur more often with induction. Therefore, it can be proven if it is these other elements or the induction medication that causes the decreased breastfeeding success.
What is best for me?
There are good reasons to induce labor, and good reasons to avoid labor induction. Certainly if there is evidence that the baby may not survive the pregnancy the right thing to do is to induce labor.
If you are considering inducing labor for convenience, you should be aware that there are significant disadvantages. Delivering a preterm baby with a miscalculated due date is one of the disadvantages. The increased cesarean rate and decreased breastfeeding rates are other disadvantages.
For women who desired to labor naturally, the medical management of labor that occurs with an induction is a strong motivation to avoid inducing labor.
Your best decision will be made when you understand the benefits and risks of labor induction and can discuss them with those caring for you during your pregnancy and birth.