Labor Induction
Can You Say, “Induce My Labor”?
Sure you can, but maybe you shouldn’t
A study recently printed in The American Journal of Obstetrics and Gynecology suggests that using medications to start labor should be reserved for situations where continuing the pregnancy presents a clear health risk to either mother or baby.
The study, conducted in Belgium, compared over 15,000 births occurring over one year (1996-7) in first-time mothers. All women had healthy, uncomplicated pregnancies. At their request, half had labor induced artificially shortly before their due dates. The other half went into labor naturally. The women with induced labors used significantly more pain medication and had more cesarean births due to both fetal distress and stalled labors. That group also had more forceps and vacuum births and had more babies admitted to intensive care.
Using medications to artificially start or induce labor has long been practiced when pregnancy is complicated by illness. High blood pressure, diabetes, and extremely overdue pregnancies are clearly understood to jeopardize health. Continuing an unhealthy pregnancy can sometimes be more dangerous than delivering the baby early, even if the induction process itself carries some risk.
Using these same techniques to induce labor for non-medical reasons has tantalized both the public and care providers for years. Indeed, the pressure to schedule births for reasons of convenience—both of patients and their providers—has resulted in growing numbers of non-medical inductions. Known as “elective induction,” this has become one of the most commonly performed medical procedures in the United States. According to the National Center for Health Statistics, about one in five labors is begun artificially, and the percentage has been rising yearly for as long as data has been collected.
Sorting out the apparent risks of inducing labor has been a vexing problem for decades. Professional organizations, such as the American College of Obstetricians and Gynecologists and the American College of Nurse Midwives, have long discouraged elective inductions. So have virtually all textbooks and the bulk of research. In spite of this, numbers rise.
Research dating back to the 1980s and earlier has consistently shown induced labors more often end in cesarean section, forceps deliveries, serious infections, and greater complications for both mother and baby. Still, many physicians have not been convinced. Earlier studies left open the question of whether birth complications resulted from the pregnancy disorders necessitating the induction or from the induction process itself. Uncertainty about the safety of induction in otherwise healthy pregnancies feeds hope of controlling one of nature’s most capricious and unpredictable agendas: birth.
This most recent Belgian study is but one of several in the last five years which have attempted to address these questions by studying only clinically similar, uncomplicated pregnancies. Most have found strikingly similar results.
Induced labors generally require stricter bed rest, omission of food and even fluids, more time on fetal monitors, and more frequent monitoring of maternal vital signs. Labors are often longer. Since the medications most commonly used are administered by IV pump, induction usually requires being tethered to that equipment as well. Because the effectiveness of the medications can be difficult to assess, especially in the long early phase of labor, vaginally placed internal monitors are often used, further restricting mobility. Women get epidural anesthesia more frequently when labor is induced, indicating that induced labors may be more painful. Perhaps the most common and disappointing complication is outright failure. Inductions simply don’t always work, and plans must be scuttled.
None of the studies advocate a passive approach to medically complicated pregnancies. But they do help to define the seriousness and risk of the induction procedure and suggest a more cautious approach to its use.
Perhaps some new drug or technique is just around the corner that will prove equal in safety and effectiveness to Mother Nature’s design. Until then, there are compelling reasons to respect her whims, at least in pregnancies uncomplicated by disease.
Editorial provided by Patrick Thornton. He is a Certified Nurse Midwife in private practice in Regent Square.
Inducing Labor Increases Risk Of Preterm Babies
· Main Category: Pregnancy / Obstetrics News
Article Date: 08 Aug 2006 - 0:00 PDT
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The pregnant woman who wakes in the middle of the night, realizes she's in labor and yells, "It's time!" is an uncommon scene. A recent survey revealed that 44 percent of women in the United States have induced labors. More than one-third of those mothers were induced for non-medical reasons. Scheduling an induction without medical indication increases the risk of giving birth to preterm baby.
Premature babies have a greater risk of medical complications. Babies born even a few days premature are more likely to endure health problems. Neither doctors nor mothers can determine a baby's due date with 100 percent accuracy. Therefore, a scheduled induction at 39 weeks could result in giving birth to a preterm baby who is only 36 weeks gestation.
According to the March of Dimes, late preterm (or near term) are babies born between 34 and 36 weeks gestation and are at increased risk for medical problems, including breathing, brain development, maintaining body temperature and weight and jaundice. Preterm babies also can encounter breastfeeding difficulties. "Near term infants are often sleepier and have less energy," says Jeanette Crenshaw, MSN, RN, IBCLC, LCCE, president elect of Lamaze International. "And preterm babies often have underdeveloped fat pads in their cheeks, which can make breastfeeding more difficult."
So why, despite the risks, does the rate of inductions continue to rise? Women and their doctors schedule induced labors for many reasons. For women with conditions, induction can be life-saving for mother and baby. However, the more recent trend is to schedule inductions for reasons of convenience. Stephanie Rosenberg, mother of one, said of her birth experience, "my doctor wanted to induce, saying 'you have a healthy baby, there's no need to go to your due date.' I was not comfortable with this-I wanted my body, as well as my baby, to be ready to deliver!"
Despite a doctor's legal responsibility to inform women on the risks of all medical procedures, many do not. As a result, women are making choices without the facts. Christina, a mother who was induced at 37 and 38 weeks for her last two births, said "my doctors did not seem concerned about me having a preterm baby and did not discuss the risks of induction."
The overuse of labor-inducing drugs increases the liability for hospitals. Knowing the risks caused by preterm birth, some hospitals have implemented guidelines that prohibit inductions before 39 or 40 weeks without a medical indication. Additionally, hospitals are taking greater care to educate mothers on the risks of early induction. Classes, such as Lamaze childbirth education classes, help teach mothers about induction as well as how to effectively communicate with their health care provider.
More information on pregnancy, birth and the use of labor-inducing medications can be found in The Official Lamaze Guide: Giving Birth with Confidence. To order the book and find a Lamaze childbirth education class in your area, visit the Lamaze International Web site at
Lamaze International > Home.