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.

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http://rchiprean.abmp.com/index.html

Wow Rebecca thanks for posting that article it was very educational. I can't believe that 44% of births are induced. What I loved about my 1st was waiting for it to happen it was so exciting when my water broke at work at 40wk6days I will also say that I also was given pictocin because my labor pains were slowing down and BOY OH BOY that made the pains 100x worse. Thanks again Rebecca.

Gosh everything in that article happened to me being induced. Long 32 hour labor, 6 hours of pushing, pitocin was VERY rough when the epi ran out, almost had to have a c-section had to have Mason vaccumed out. Then I was cut & torn muscles so badly... recovery was painful and LONG.

I didn't get induced by choice I developed preclampsia and was 40 weeks 2 days. They wanted to induce me at 39 weeks but I refused and finally was forced when it became unsafe. I wouldn't EVER want to do that again that's for sure!!

I hope I am lucky enough next time to wait until the baby is ready.

I wonder a lot if that is why Mason has an under developed digestive sytem, acid reflux and apnea issues because he just wasn't done cooking.

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Rebecca thanks for posting that!! I agree too many births being induced for non medical reasons these days, I wouldnt ever want that to be me, if the baby doesnt come on their own, they just arent ready yet

This is so true and has already happened on this very site to a couple of mothers, Im sure they will share their stories!

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Could be but I guess you will never know

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Judith - Wow that is a really good point about Mason, that might be why he has had so much trouble. He just wasn't ready yet.

I would say 90% of the deliveries at our hospital are inductions or scheduled c-sections either because of a prior c-section or an elective c-section. We have a waiting list for inductions and if we get busy and have to cancel someone, wow do they get mad and start cussing us out When I worked nights we rarely had women come in in labor because everyone gets induced. The doctors stand point on it is if a woman throws a fit to be induced and they say no and then something happens to her baby they are liable so they really don't have a choice for fear of a lawsuit. Same with elective c-sections. If they refuse and the woman goes into labor and something happens to the baby, the patient can say I asked for a c-section and was denied.

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But what is stopping "every" woman from saying that and then something like what happened to Karen where Riley was NOT 38 weeks but 35 weeks ( because u/s's are NOT 100% accurate!!!) and look at all the problems she has to deal with, vision, growth etc, Riley has to wear contacts.. I just think this is ridiculous for NON medical reasons! Then what do the dr's say? oops sorry , this is just crazy and I wouldnt want it to be me or my child

Something worse is bound to happen at one point or another

Our Dr's here for NON risk pregnancies WONT even check you til 38/39 weeks. I think people need to learn all the facts before deciding on something like this, JMO

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Speaking of someone currently in these shoes.......

I am very tempted to ask my Dr to induce me. I am very uncomfortable and ready for her to be born. And thanks to my fertility treatments and charting, I know exactly how far along she is.

But then I think to myself that it's just not worth the risks. Yes, I know for sure how many weeks she is, but she develops at her own rate, and she may not be where "most" babies are at almost 37 weeks.

It has always been my intention to not induce unless my Dr looked at me and said "you have to." But I can definatley see the appeal of simply knowing when it will be over. I think the fact that I am basicly floating to an unknown goal is what is making it so hard for me.

on the "knowing how many weeks you baby is" a mom on here thought she knew too and knew the day of her last period etc but it wasnt the case with her baby, so just remember "nothing" is certain 100% of the time

I wish everyone the best!!

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I understand what you are saying, but I feel confident in the dates I know.

I am with Mere, my ovulation date is right on with all my ultrasound pictures. My baby has been average size at all 4 u/s. They can't be off then more then a few days.

That being said I don't think I would induce until after 40 weeks. Our hospital doesn't let you go past 42 weeks due to the deterioration of the placenta.

I have had this talk with my doctor and the plan is to induce a 5 days after my due date.

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I know 3 people in the last year who have been induced b/c they were ready to have the baby - 2 were scheduled on the due date. 2 of these friends were in labor for 12 hours before having emergency c-sections, the other didn't have a c-section, but was in labor for 48 hours.
I was tired of being pg and my bp was going up, each week, but my dr. waited until 2 days before my due date, and a/b 6 u/s before scheduling my c-section. I didn't ask for it. He told me he could induce me but he knew it wouldn't work b/c of the position of the baby and that I would probably end up with a c-section after a long labor that would put unnecessary stress on the baby. He said inducing babies in that position had been linked to brain damage b/c of the stress.

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80% of first time babies are born "late" at 41 weeks. So that is normal to go past 40 weeks and the baby not be ready. I really think you have to go with the attitude that 42 weeks is term and anything before is great other wise you will drive yourself crazy trying to guess.

I walked around 3 cm for weeks, lost my mucas plug, was a few days past due and Mason still wasn't here so checking for dilation doesn't really tell you much.

Just like Tweety posted she had no dilation at all and went into labor. Just because you aren't dilated doesn't mean you won't have your baby before someone who is 3 cm dilated. So hang in there girls. It could be any day for anyone no matter what stage your cervix is at!!

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Mere~ I understand where you're coming from!

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Tammy, I am not sure how that happened to Riley. I don't know if Karen was charting, had an early sono or how they determined her due date but our doctors do sono's at 8 weeks gestation and they are really accurate done that early.

Mere, I don't blame you. I didn't want to be induced with Jack but by 39 weeks I was done. He was healthy and it was really nice knowing that I had daycare for my older children and my bag ready to go so we didn't forget anything.

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