Lets face it! The last couple weeks of pregnancy are miserable, uncomfortable, and downright painful for some women. One thing women do not take into consideration in most cases in the end of pregnancy are the risks of labor induction, and the benefits of allowing labor to start on its own without medical intervention to jump start it.
With nearly half of all American women having their labors started, and 60% of women having their labor augmented or sped up in the hospital through medications, this information is increasingly important.
But why should women let labor start on its own?
There are a variety of different reasons :
- Pitocin contractions are much stronger than contractions of a normal labor. I can attest to this as I have had pitocin with one labor, and a natural labor with my second child. Pitocin causes much stronger contractions which can have an impact on mom and baby.
- Induction normally requires some kind of an IV line, which can make getting comfortable, changing positions, or moving around much more difficult.
- Because induction drugs such as pitocin cause longer, and stronger contractions, this can sometimes set the baby into fetal distress, which is typically seen with heart rate issues.
- When your labor starts on its own, in the majority of cases, you can know that your baby is truly ready to be born.
A 2007 research study showed an increased risk for complications in inducted labor which included :
- Increased use of vacuum extraction, or forcep-assisted delivery.
- Cesarean Section (40% of all inductions will end in a cesarean delivery)
- Increased use or need for an epidural, or medication based pain relief methods.
- Babies born with low birth weights.
- An increase in late pre-term deliveries. (33-36 weeks gestation)
- Longer hospital stays
- Increased NICU stays for the newborns
But how do you know when labor induction is necessary, and when it is not?
In some cases, and conditions during pregnancy, a labor induction may be medically necessary, and it is important you speak with a trusted provider about these situations to discuss the risks and benefits, and weigh out your own situation.
The American Congress of Obstetricians and Gynecologists (ACOG) formally known as the American College of Obstetricians and Gynecologists has set guidelines for labor induction, and in some cases their own members are not following these guidelines and suggestions. The six situations that ACOG has identified, and recommended induction for are :
- Ruptured membranes for longer than 12-24 hours. Meaning, if your water has broken, and your labor has not started within 12-24 hours, augmenting of labor may be medically necessary. This does not mean that the baby must be delivered within 12-24 hours of the water breaking!
- You have an increase in your blood pressure caused by the pregnancy, or a condition we know called preeclampsia.
- Your pregnancy is post term, or overdue. This means over 42 weeks gestation. Not because you have met your due date.
- You have other health issues such as diabetes, or gestational diabetes that could have an impact on the health of your baby.
- Your baby is growing too slowly, or may be suffering from a form of intrauterine growth restriction (IUGR).
- An infection in the uterus.
When is induction not necessary?
Induction is not medically necessary, or necessary in several cases or situations we see many inductions taking place for today. Some of these reasons include :
- A suspected “big baby“ If mom and baby are healthy, and fine, induction for fetal macrosomia (a baby bigger than 8 pounds 12 ounces) is not a reason for an induction.
- You are uncomfortable…
- Your amniotic fluid is low, but you and your baby are otherwise healthy.
We are all uncomfortable towards the end of our pregnancies! We have a bowling ball sitting on our bladder and grinding into our pelvic bone, it is just preparation of the uncomfortable situations motherhood is going to bring too! Hahah!
What kind of questions should you ask your provider if induction is suggested?
Being a critical thinker, investigator, and overall looking into your care is almost always a smart idea, and can help you out in the long run. I learned this through my first pregnancy, and it make my second pregnancy and birth much more pleasant. Some sample questions include :
- Why are you recommending labor induction?
- What are the risks to me, and my baby if I wait for labor to begin naturally?
- Can we try more natural methods of induction before using drugs?
- What kind of natural methods of induction do you recommend?
- Are there any research studies that show decreased risk, and decreased likelihood of a unhealthy outcome in my situation?
- Is my induction likely to be successful?
- What is my Bishop Score and how does that impact my success rate?
- Is my cervix ripe? (Your provider can tell you if your cervix is ripe. Women who are induced before their cervix is ripe are much more likely to have cesareans, even if cervical ripening drugs are used.)
Just to close my post up today… A due date is not a deadline! In most cases, studies show that estimated due dates, can and still are up to two full weeks incorrect in either direction today. With the advances in ultrasound technology, and other methods of dating a pregnancy, there is still room for error.