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To induce or not to induce


For many pregnant women today, THAT is the question. Nearly 1 in 4 women in the US have their labor induced.

What is induction? The stimulation of uterine contractions during pregnancy (before labor begins on its own) to attempt a vaginal birth. Your doctor or midwife may use hormonal, physical, or medicinal methods to start contractions.  

Some inductions are medically necessary. Induction is a wonderful tool for babies and mothers who need help to have a safe labor. According to Lamaze.org, some scenarios that indicate the need for induction are...

  • You’re showing few signs of labor by 42 confirmed weeks of pregnancy

  • You have a medical disease that is not responding to treatment

  • You have high blood pressure or preeclampsia 

  • Your labor isn’t starting after your water breaks and you have a Group B Strep positive culture

  • You have a uterine infection

  • There’s not enough amniotic fluid surrounding the baby 

  • Your baby’s growth has been slow for his or her age

About 19% of inductions are done for non medical reasons. The most common reasons given for performing inductions that aren't medically indicated are fear that the baby is growing too large or that the woman has gone beyond her due date. It is often difficult to estimate baby's weight in utero and due dates are far from an exact science- you can find more detailed information on both of those scenarios at Evidence Based Birth and be prepared to have an informed discussion with your provider.

What about elective inductions? Sometimes women at the end of pregnancy ask their provider if they can induce labor. Especially during the holiday season, many women may feel the urge to arrange their birth when their doctor is in town, relatives are free to visit, and they don't have to worry about travel or conflicts with seasonal celebrations. Some women have also reported feeling pushed into an induction decision by their doctor or midwife when the situation wasn’t medically urgent. Labor is a great unknown for most women, and at first glance it’s understandable to want birth to happen in a way that gives the mother some control. Providers are humans too and they’re often overworked, overscheduled, and trying to be as present as they can for all their patients. So...is arranging a mutually agreeable time to start labor a good idea for healthy pregnancies? Not really. 

WHY should you and HOW can you avoid an induction that isn’t medically necessary? 

The WHY

Induction is a process and a significant medical intervention. Risks of inductions include hyper-stimulation of the uterus (the uterus contracts too frequently, decreasing blood flow to the baby), the use of extra interventions such as continuous fetal monitoring, the need for additional pain relief, and a failed induction leading to a Cesarean (NICE Guidelines, 2008). If you have a medical indication then the benefits of beginning labor outweigh the risks of an induction. However, many women are led to believe that induction is risk free and that is not the case. 

It's tough to know exactly how mature your developing baby is and when he's ready to be born. An elective induction performed at what is thought to be 39 weeks can sometimes result in a 37 week old baby that could have used that extra time to grow. Babies born in this early term period also have a higher risk for breastfeeding problems. 

No one knows exactly why labor begins when it does. It involves input from a woman's body, her baby, and environmental cues. When your labor begins spontaneously..

  • It may be less painful, shorter, and more productive  

  • Your baby may have a lower risk of respiratory distress.

  • You may reduce your risk of cesarean section.

  • You reduce the health costs associated with your birth.

  • You may have less need for pain medication.

  • You may have a faster recovery.

  • You may find it easier to bond and attach to your new baby.

The HOW

Do your pregnancy homework. Educate yourself about childbirth and what your options are. Choose your medical provider carefully. A doctor who has an induction rate of 50% isn't going to change their practice for you. Find someone whose philosophy of birth aligns with yours and who is willing to discuss your care and address your concerns respectfully. Consider using a midwife (in or out of the hospital)- they are typically less likely to intervene in a normal pregnancy than an OB. Choose a provider whom you trust. If you have little choice in your birthing options, a doula can be a valuable source of knowledge and encouragement. 

Understand informed consent. You must give consent for any test, treatment, drug, or procedure recommended by your care provider. You have the right to ask questions and have them answered so that you are fully aware of the risks, benefits, and alternatives to what is being recommended. You ultimately have the right to ask for another opinion or to refuse any recommendation that you aren't in agreement with. Continue collecting information to make the best informed decision that you can. 

Know the right questions to ask when an induction of labor is suggested.

  • Why is induction being recommended for me and my baby? Is it medically necessary?

  • What are the risks and benefits of choosing to do an induction now? 

  • What are the risks and benefits of choosing to wait? 

  • Are there any alternatives treatments or suggestions? 

  • How will being induced affect my plans for labor? (in some cases mobility and eating are restricted)

  • Is my cervix favorable for induction? See Bishop scoring

  • When is the induction considered to be unsuccessful and what are the next steps? 

  • May I talk with my partner and let you know our decision soon?

Trust that in most cases, your baby and your body know exactly when labor should begin. 

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