Inducing Labor
Some things just should not be done on a schedule!
In this busy world, the impulse to schedule everything is tempting. However, when it come to birth, it is better to let nature have the final say of when the baby should make his or her debut. A non medical or elective induction carries a higher risk for both mother and baby. An elective induction is any induction done to bring on labor prior to the woman going into labor on her own; that is, one done for convenience of the mother, family or doctor but not for a medical indication.
Some of the medical indications include complications associated with hypertension, poorly controlled diabetes and some blood incompatibility problems . Post maturity, pregnancy that has gone past the normal period of gestation of up to 42 weeks, may be a medical indication for induction because the placenta may decrease in its ability to provide for the baby. Among other parameters, after 40 weeks the woman is assessed to be certain that there is no reduction in amniotic fluid and the baby’s heart rate is reacting appropriately to increased oxygen need such as when the baby moves. This can be done with a simple ultrasound and fetal monitor. These tests are called NST and biophysical profiles. When these tests consistently indicate a healthy placenta and baby, the pregnancy can be continued until the mother goes into labor on her own (American College of Obstetricians and Gynecologists, 2004).
Some problems with inductions include:
- The woman’s body is just not ready, and her labor will not progress to a vaginal birth, resulting in a cesarean section for failure to progress (Ben-Haroush et al., 2004; Glantz, 2005).
- Contractions from induction medications can be too strong and lead to fetal distress (Ben-Haroush et al.; Glantz, 2005).
- Labors that are induced are more likely to have increased blood loss postpartum due to the fact that the woman’s uterus is fatigued and does not contract well after the birth.
- Inductions usually require strong pain medications including epidurals, which lead to more vacuum or forceps deliveries. This is not only hard on the baby but also increases maternal episiotomies and lacerations of the perineum (more tears).
- The baby’s due date may not be correct and the baby is delivered preterm leading to many neonatal complications (Kramer et al., 2000). This happens much more often than you would think! According to the March of Dimes, even a few weeks makes a difference:
Late preterm infants are typically healthier than very preterm infants, but have elevated risks for potentially serious health problems when compared to term infants. The lungs and brain are among the last systems to fully mature during gestation, and complications can arise due to the immaturity. Complications among neonates delivered late preterm include temperature instability, feeding difficulties, breathing problems like respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN) and jaundice. (2006, p. 1)
Sometimes a woman will be encouraged to be induced because the baby is getting big. This can sound pretty scary when she thinks of pushing out a big baby! The American College of Obstetricians and Gynecologists warns against inductions for suspected big babies (Horrigan, 2001; Leaphart, Meyer, & Capeless, 1997). Estimation of fetal size is often off by up to 2 pounds and is not a good reason to induce.
As the rate of cesarean sections continues to rise, so does the rate of complications. For the first time in history we are seeing an increase in maternal mortality rates in the USA and these are directly related to the increase in cesarean sections.