This week, Mother’s Advocate is proud to present well-known and respected childbirth educator and author, Nicette Jukelevics. Nicette is blogging on behalf of the Coalition of Improving Maternity Services (CIMS), and has given us a straightforward, detailed look at labor induction.
Although there is no evidence to show that non-medically indicated inductions improve outcomes for babies, inductions for non-medical reasons have been on the rise in the U.S. Increasingly, labors are being induced for psychosocial reasons and for medical convenience. What’s more, the majority of expectant mothers are not aware of the risks of elective induction when they request one or when their caregiver schedules it.
We are learning, however, that with a healthy pregnancy, not waiting until labor starts on its own may have far greater health consequences for babies than we knew. Research shows that when births are induced or cesarean sections are scheduled — especially before the 39th week of pregnancy — newborns may appear mature, but they are at greater risk for short- and long-term complications.
Labor Induction: Alarming Statistics
In 2005, 22.3 percent of all U.S. births were induced — a 50 percent increase since 1990. A national survey by Childbirth Connection showed that 21 percent of U.S. women who gave birth in 2005 tried to self-induce labor because they were tired of being pregnant. They wanted to induce to avoid a medical induction, to control the timing of their birth, or because their caregivers were concerned about the size of the baby.
Elective induction rates vary widely among hospitals (12 percent to 55 percent) and among individual physicians (3 percent to 76 percent). But more than four out of 10 mothers (41 percent) reported that their caregiver tried to induce labor. For some women, an elective induction can almost double the risk for a cesarean, depending on the individual physician’s practice style and medical specialty. And all of these statistics are even more frightening when compared to the World Health Organization’s recommendation that appropriate induction rates in any geographic region should not exceed 10 percent.
Labor Induction: The Risks
With an elective induction, babies are more likely to suffer from hypoglycemia, to be admitted to a special care nursery, and to need ventilator support. A recent study of a U.S. healthcare system showed that babies born at 37 weeks were 22.5 times more likely to need a ventilator at birth, and babies born at 38 weeks 7.5 times more likely, when compared to babies born at 39 weeks. Babies born too soon are also more likely to experience serious complications, including fever, infection, respiratory distress syndrome (RDS), and transient tachypnea of the newborn (TTN).
These babies may look normal, but have an increased risk of difficulties with vision and hearing, feeding and digesting their food, regulating their body temperature, and are more likely to need phototherapy to treat jaundice.
The newest research on babies born before term indicates the potential for neurological problems and learning difficulties that may not show up for years. The March of Dimes is educating healthcare professionals and mothers alike about the important brain growth and fetal neurological developments that take place in the very last weeks of pregnancy. At 35 weeks, a baby’s brain weighs two-thirds what it will weigh at 39-40 weeks. At 37 weeks, the brain weighs only 80 percent of its weight at 40 weeks. The cerebral cortex — the part of the brain that controls functions such as cognition, perception, reason and motor control — is the last to develop. Researchers have found that babies born pre-term are more likely to have learning difficulties at school age. It’s essential for baby’s brain development that the pregnancy goes to full-term.
Labor Induction: Consider This
An induction of labor is a complex process that often requires additional medical interventions to keep the mother and baby safe from successive potential complications. Inducing labor with pitocin when the cervix is unripe (long and closed) sometimes causes the mother to labor for long hours with little progress. Subsequently, confining the mother to bed, using continuous fetal monitoring and IVs, and administering an epidural for pain are commonplace with an induction. Shoulder dystocia (when the baby’s shoulders cannot fit through the pelvis), and the use of forceps or a vacuum extractor are also increased with induction. All of these interventions and complications can lead to higher risk of cesarean section — failed inductions are not uncommon.
Labor Induction: When it’s Helpful
Regardless of all the risks, there are several medical indications for inducing labor — when the mother or the baby’s health would benefit more from the induction than from continuing the pregnancy. These may include diabetes, pre-eclampsia (high blood pressure), or a uterine infection in the mother. Or when a baby in utero is not growing at a normal rate (small for gestational age) or the pregnancy is post-term (more than 42 weeks). Induction may also be favorable when the bag of waters breaks prematurely (also known as PROM, premature rupture of the membranes).
Labor Induction: Questions to Ask Your Provider if it’s Suggested
- Why are you scheduling an induction of labor?
- What are the risks of inducing my labor?
- I know that my due date is only an estimate. What precautions will you take to make sure my baby is not born too early?
- How do you plan to induce my labor?
- How will an induction affect my labor and the health of my baby?
- I know that compared to waiting for labor to begin on its own, an induction is more likely to lead to a cesarean section. What measures would you take to reduce my odds for a cesarean?
If both you and your baby are healthy and stable, don’t hesitate to take time to consider your caregiver’s recommendations and explanations. Feel free to leave the appointment, with a follow-up scheduled — or to get a second opinion. After all, this is your birth.
The last week or two of pregnancy may be difficult. Priorities at work, or scheduling maternity leave to accommodate childcare or family needs may be a priority. However, waiting for labor to begin on its own is safer for you and your baby — and safety is of the utmost importance!
Nicette Jukelevics, MA, ICCE is a childbirth educator, researcher and author of “Understanding the Dangers of Cesarean Birth: Making Informed Decisions.” She is also the founder and publisher of VBAC.com. Nicette is past-chair of CIMS, and now serves as chair of the CIMS Coalition Building Committee. She has also served on the Board of the International Childbirth Education Association and DONA International. For more than 25 years, Nicette had the privilege of helping thousands of expectant families prepare for childbirth, VBAC and early parenting. She has presented on cesarean and VBAC issues at national conferences, and for advanced doula trainings across the U.S. With co-author, Henci Goer, Nicette recently published “The Risks of Cesarean Section & Expectant Mother’s Checklist,” a Coalition For Improving Maternity Services (CIMS) Fact Sheet.
Other resources: California Maternal Quality Care Collaborative
Tell us about your labor. Did (or will you let) your labor begin naturally? Was (or are you planning on having) your labor induced? We’re looking forward to hearing about your experiences!
Great article! More moms (and docs) need to be aware of the problems of non-medically indicated induction!
I think its also important to mention that ultrasounds and estimating age based on last menstrual period can be up to 3 weeks off. So if your doctor says they are inducing you at 39 weeks, your baby may actually be 36 or 37 weeks and at risk for neurological and lung problems! A VERY important note to make, technology is not perfect!
This is a wonderful article. If only more women knew about the risks of induction!
I was uneducated, hot, and tired when I went to my 41 week appt. in the middle of August. I was 8 days overdue. My CNM scheduled me for a biophysical profile ultrasound. My score was 7/8. I received a 7 and not an 8 because my amniotic fluid was at the low end of the normal range. I was told to immediately go to the hospital. I was placed on fetal monitoring (all was fine), and induced the next morning. By 2PM I was headed into the operating room to have my baby delivered by c-section– fetal distress after pictocin and artificial rupture of membranes. I was devastated and still suffer some emotional trauma from that day. I had a beautiful baby boy.
I chose to have a home birth with my next baby, for various reasons. My midwife is awesome and believed in my body to do what it was created to do! It was a long wait, but I finally went into labor at 41 weeks 4 days. It seemed like I would never actually go into labor, but I did!!After 57 hours of labor including 5 hours of pushing, I pushed a beautiful baby girl into the world nearly 2 weeks overdue.
57 hours of labor without pitocin was much better to manage than the 6 hours I labored with pitocin when I had my son.
Induction (for the wrong reasons) stinks and often has bad results!!
[…] the information about brain development in the last few weeks of pregnancy found in this excellent Mother’s Advocate post about labor induction, as well as research indicating that the surfactant produced in baby’s lungs to prepare for […]
Hi, Kara
I’m glad you found the article helpful. You are right about the margin of error in estimating due dates.
Many women have their labor induced because they have been told that their pregnancy has gone past their due date. Induction of labor for healthy women increases the risk for a cesarean. About 4% to 14% of women do not go into labor on their own by the end of the 42nd week. Calculating the due date by going back to the first day of the last menstrual period, as it is often done may be an inaccurate form of measure. This method is based on a 28 day menstrual cycle. If a woman’s cycle is other than 28 days or if she became pregnant while she was on oral contraceptives or soon after their use the date may be off by three days. Often women are induced because they don’t go into spontaneous labor by their due date increasing their risk for cesarean section. Evidence shows that calculating the due date based on an early ultrasound scan is a more accurate method of estimating the due date and would avoid induction for an otherwise post due pregnancy.
Nicette
Hello, Cheryl
Thank you for your kind words about the article. I’m sorry that you had a traumatic experience with your first birth. As with many birth interventions, induction can impact women physically and psychologically. You chose to educate yourself and find the support that you needed for your second birth. That’s what many women do.
I think there will be changes made about elective inductions because of the current national campaign to educate care providers, hospitals, and expectant families about the risks of inductions. I just read an article in the Minnesota Star Tribune stating that the State Department of Health and Human Services is asking hospitals to come up with a plan to reduce elective inductions. You can read the article on the CIMS Facebook page.
http://www.facebook.com/reqs.php#!/CoalitionforImprovingMaternityServices
Nicette
Thank you for posting this article on your blog and spreading the word about the impact of elective inductions.
Nicette
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Thanks for this! I found you because I’m a doula in training and a blogger and am trying to assemble resources specific to moms who are past their EDD and wanting to inform themselves about natural induction options…I’ve had many friends and friends of friends calling me with questions about this and when they don’t have a doula or midwife or OB who is well-educated on natural induction options, I’m unsure of where to send them! any ideas you could offer would be MOST WELCOME.
[…] Mother’s Advocate on Induced Labor […]
I self induced my labor, the story is on http://theloveofelephants.blogspot.com/2012/05/birth-story-unmedicated-and-self.html
[…] Labor Induction: Exposed […]
This article is very informative but I wanted to know the statistics for having an induction when you are over 40 years old. Which this article doesn’t mention at all. Thanks
Awesome article! Thank you for explaining the situation around induced labor and what it means for mother around the world. This information is so necessary to spread to expecting mothers. We work to spread information and educate around safe, peaceful childbirth around the world, at Midwife International. We work to train midwives who are equipped to work in resource-constrained regions where infant and maternal mortality is high and the need for midwives is great. For more information, please visit: http://midwifeinternational.org/midwife-training/.
Thank you for all that you do!
[…] A woman who has a c-section has a longer recovery time, a higher chance of infection, a higher chance of severe bleeding, a higher chance of scarring and difficulties with future pregnancies and deliveries and much more. […]
This is a great article. It is one of the more unbiased one’s I have found in my search for information. I have a question for anyone who might be able to help me- I’m getting a little desperate.With my first kid I waited until 42 wks 4 days before being induced- I had dilated to 3 cm, anterior, effaced cervix for wks, but never went into active labor. My son almost died, he was pretty big by that point and I happen to have a narrow pelvis. He made it through, but not without a 2 for a five minute apgar and a stint in the NICU. With my second I waited ten days before being induced- again 3-4 cm, anterior, effaced no active labor insight. This induction went smoother, though my second was about the same size as my first. My OB says my babies’ heads don’t enter my pelvis until pushing phase is well underway… and here is where my question is: I am now 38wks6days with my third, and I am trying to figure out if there is a reason(s) that I do not go into labor. I don’t think the whole “my body isn’t ready”, “the baby isn’t ready”, stuff applies to my situation. Both of my kids, especially my first, showed signs of post maturity, and my body sailed through pre-labor. This little one even seems to be in a favorable position most of the time (she wiggles between facing my left hip and my spine). I would really like to avoid induction, and I’m not finding many answers besides “some people gestate longer”, and “baby isn’t ready”. I am beginning to wonder if I am just one of those people for whom medical induction is intended, but I am kind of hoping not. Thoughts anyone? I just don’t know what to do.
This blog was… how do I say it? Relevant!! Finally I have found something which helped me. Kudos!
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No evidence that non-indicted lbor induction improves birth outcomes? Very untrue! Recently published meta-analysis of randomized clinical trials of non-indiced labor induction found lower rates of cesarean delivery and a trend towards a lower rate of term stillbirth. S Wood. BJOG 2013.
James M. Nicholson MD MSCE
Penn State Hershey
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