Do you know the reasons for an induction?

The Listening to Mothers II survey revealed an interesting statistic. Half of the women in their survey had attempted to induce labor. 22% tried to start labor on their own at home and 41% had used medical induction methods. 39% of the respondents were actually successful at causing labor to start.

Even more interesting is the reasons women gave for their need to induce labor. Nearly 60% of the women who attempted self induction and 20% of the women who attempted a medical induction did so because the mother wanted to get the pregnancy over with. Another 16% of those who attempted medical induction did so to have control over the labor, such as choosing the timing or to ensure a specific provider was on call.

The US Hospital Discharge Survey gives more evidence of the convenience of induction. There were an average of 13,045 births on any given Tuesday during 2004. There were only an average of 7,501 on any given Sunday. The only possible explanation for an almost double number of births on Tuesday is the scheduling of cesareans and inductions.

Though we have a wide range of research on which methods are the most effective at starting labor, we have very little research on when artificially starting labor is safe or helpful. Instead, induction decisions are based on assumptions that may or may not be true.

The last few weeks and days of pregnancy are important to the development of a baby. Not only are the lungs preparing for the first breath, but the baby is also preparing for life outside the womb in other ways. For example, in the last days of pregnancy the baby begins storing iron to help prevent anemia. The baby is also putting on extra fat which will help to maintain body temperature. Because of this, many hospitals have adopted a protocol prohibiting elective inductions before 39 weeks gestation.

Choosing to artificially end a pregnancy is one of the most dramatic ways to alter your child’s development. It is also one of the most dramatic ways to alter the normal course of labor and birth. Because of this, the decision to induce should be made only when the risks of inducing are outweighed by the benefit of the baby being born. In most cases, women can safely go into labor on their own, even though this may mean waiting. The American College of Obstetricians and Gynecologists does not recommend elective induction (starting labor without medical reason).

Toxemia, Pre-Eclampsia

This is a dangerous condition in pregnancy. Left untreated it can send the mother into convulsions and can cause death. A woman who develops pre-eclampsia will be monitored more frequently than a lower risk woman, and if the midwife’s assessment indecates worsening condition, induction may be recommended. In the 1960’s, Dr. Thomas Brewer conducted research that concluded it is a nutritional problem that can be corrected during pregnancy. His claims have not been supported by other researchers, however good nutrition will always be a benefit even if it does not prevent toxemia.

Gestational Diabetes

For some women with gestational diabetes, health care providers suggest starting labor early to prevent problems in labor due to a “too big” baby, also known as macrosomia. The concern is a baby whose bones, specifically the shoulders, are too large to be birthed safely. Gestational Diabetes appears in 2 – 12% of the population of the US (wide variation cited by researchers), and in most cases proper nutrition and exercise can have a tremendous impact on the health of the mother and baby.

Overdue Baby

The concern with a baby who is overdue is not that the baby is late, but that being late will cause a problem for the baby. Sometimes when a pregnancy goes over 42 weeks the placenta begins to age, decreasing its effectiveness at giving the baby oxygen and food. If this happens, the baby becomes sick and is considered “post mature.” Because this only happens in pregnancies over 42 weeks, most health care providers will not allow a pregnancy to continue beyond that.

If your pregnancy has gone beyond the accepted norm of 42 weeks, it is possible that your baby is healthy and will benefit from more time in the uterus. To determine the health of your baby you may do fetal kick counting or you can undergo stress or non-stress tests in your doctor’s office.

Large Baby

Some practitioners will suggest beginning labor if they believe the baby will be too large for the mother to give birth. There is no way for a doctor to accurately predict the size of the baby (ultrasound can be wrong a pound or more either way), or to predict the amount the pelvis will stretch during labor. The only way to accurately diagnose a baby that is too large to be born is to have a trial of labor with adequate pushing time.

A similar concern among mothers is often that a large baby is more difficult or painful to push out. It is important to remember that the difference between a baby born at 38 weeks and a baby born at 42 weeks is generally 2 pounds of fat (not bony tissues) since the major growth for the baby has been completed and the last month of pregnancy is spent in building fat supplies to help the baby survive the first week of life. Fatty tissue is mushy and pliable and can squeeze out easily. The size of bony tissue is more related to genetics than whether or not the baby had an extra week in the uterus.