Induction -- Risky Business or Blessed Reprieve?

Much of the information for this post was taken from Penny Simkin's book Pregnancy, Childbirth and the Newborn (pages 260-261).

Inducement, or the artificial starting of labor before it begins spontaneously, is probably the most common medical intervention during late pregnancy. While the majority of inductions are elective or planned, some are for medical reasons. A few of the most common reasons your physician might suggest this type of induction are:

• Prolonged pregnancy
• Prolonged rupture of membranes
• Fetus who is no longer thriving or growing in the uterus
• You are suffering from an illness, such as high-blood pressure or diabetes, which puts both mother and baby at risk.

When any of these conditions is presented, usually tests are performed and monitoring is done to determine the readiness of the mother and baby for birth. It is important to understand that some hospitals and physicians may have specific policies that determine when your baby is to be born (before 41 weeks gestation, within 24 hours of membrane rupture, etc.), despite the health of mother and baby. All medical interventions carry with them risks, which I'll talk more about later on, so it is important to find out what your care provider's policies are ahead of time, so that you can make sure you are both on the same page when it comes to how you would like your child to be born.

As mentioned earlier, the vast majority of inductions are for non-medical reasons, and the induction rate is increasing at the same pace as the cesarean rate (could there be a link?). There are many, many reasons that someone may decide to have an elective induction. These reasons include:

• Convenience for the caregiver or mother is the most common reason for elective induction. Many doctors work in large practices where they are only on-call during certain days of the week. A woman may want to deliver with a specific doctor and therefore will schedule when she is available. Doctors also like to deliver their primary clients' babies. They are eligible to receive the largest chunk of the fee if they attend the delivery.
• Predictability is very appealing to many women, especially those with other children, whom they will have to find care for when they go to deliver their baby. Women who experience very rapid labor and birth, or live far away, may worry that they will not make it to the birth center on time.
• For some, the last few weeks of pregnancy are unbearable.
• Both women and caregivers may worry that if they wait for the baby to be born spontaneously, he will grow too large and will not be able to fit through the pelvis and cause damage to the perineum. Please note that studies have found that fetal measurements done by ultrasound and by external measurement cannot be counted as predictors for actual fetal size. There can be as much as a 10% margin of error using these methods.
• Sometimes caregivers and their patients go ahead with an induction simply because there seems to be no apparent reason not to do it. The cervix is ripe (soft and effaced), the baby seems big enough, and the mother is ready to have her baby. The question becomes, "Why not?" rather than "Why?"

Induction is seductive. It can be one of the greatest temptations a very pregnant mother can face, but it is important to understand that it is not a risk-free procedure, especially for first-time mothers. Here are some things to think about:

• Babies have something called a "fetal-placental clock", which greatly influences when she is ready to be born. Babies continue to mature and develop in the last few weeks of pregnancy and may benefit from a few more days in the uterus.
• As mentioned, induction is not risk-free, and there is no guarantee that it will be successful. The chances of a cesarean are much greater for those that choose induction as opposed to those with spontaneous onset of labor, especially for first-time mothers (which is the group most likely to go over-due).
• An induction can take as little as four hours or as long as three days. A long or unsuccessful induction is more likely if there is little dilation or effacement before admission to the hospital, and if you are a first-time mother.
• Continuous monitoring is pretty much inevitable if you are induced. You will be limited in where you are able to position yourself (usually on your side or on your back, in bed), which can make it very difficult to deal with the intensity of contractions.
• You usually are not allowed to eat solid foods while Pitocin is running, though you can usually drink clear liquids. If you have a long wait, you can get pretty hungry.
• Induced labors, even in early labor, may be more painful and intense than a spontaneous labor, usually leading to more interventions to assist in pain relief.

If you or your physician are considering an induction, make sure that you are clear if it is medically indicated or elective. Weigh your options so that you can make an informed decision that is best for you and your baby. When offered an elective induction, some women decide to wait for labor to begin spontaneously, while other may decide to go ahead with the procedure, feeling that the benefits outweigh the potential risks. Only you will know what is best for you and your family.

Stay tuned for: Possible Ways to Get Labor Going on Your Own