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Archive for the ‘Labor induction’ Category

Does early elective birth impact fetal development?  Kristen Oganowski — doula, blogger, aspiring childbirth educator, PhD candidate and mother of two — weighs the risks associated with early induction.

As women near the end of their pregnancies, many encounter an onslaught of questions and comments from friends, family members, and even their care providers about when their babies will be born:

“So, when are you going to induce?!”

“Do you have your c-section scheduled yet?”

“Since 37 weeks is ‘full term,’ why don’t you just schedule and induction already?”

“Babies really only gain weight during the last few weeks of pregnancy, so we can schedule your induction or cesarean section as soon as you’re technically full term!”

But as casually as people discuss scheduled birth in everyday conversation, current research shows that the topic might deserve a bit more seriousness after all.  In fact, the topic of early elective birth has been buzzing throughout the world of maternity care advocacy lately.

Early elective births are scheduled cesarean sections or inductions of labor that occur prior to 39 weeks and without medical indication.  And while many care providers and moms choose to schedule birth before the 39th week of pregnancy, one message has become increasingly clear in recent years:

Because of the risks associated with early elective induction, women and their care providers should avoid scheduling elective inductions or cesarean sections before 39 weeks.

Research shows that when babies’ births are scheduled before 39 weeks, they are at an increased risk for respiratory problems, NICU admission, and even neonatal and infant death.  These risks are serious, and they have even prompted various hospitals in the United States either or to require onerous paperwork in the event of an early scheduled birth or to prohibit early elective births altogether in order to minimize these risks.

Acknowledging both the seriousness of these risks and the fact that the induction and cesarean rates have been growing with alarming frequency over the past two decades, The Leapfrog Group (a hospital quality watchdog group) recently released the results of a survey documenting the rates of early elective births at hospitals across the United States.  Setting a target rate of 12%, the Leapfrog Group found that the hospitals’ rates varied from nearly 0% to well over 50%.  Notably, the wide variations in these rates even occurred in hospitals within the same city or region.

On the one hand, these results (which hospitals offered voluntarily) demonstrate just how crucial it is for women to know not only their own care provider’s induction and cesarean rates but also the rates and patterns of early elective birth at the location where they will give birth.  On the other hand, they also demonstrate just how important it is for women to know why they should think twice about scheduling their babies’ births before 39 weeks.  Avoiding early elective birth isn’t about trying to make busy families’ lives more inconvenient—it is about protecting their new babies from the harms of scheduling their births too early!

This doesn’t mean that inductions and cesarean sections should never happen before 39 weeks.  When scheduling birth is medically indicated—when a mother and/or her baby’s health would be compromised by continuing pregnancy—then the benefits of an early birth certainly outweigh the risks.  To this effect, Childbirth Connection has published a resource on labor induction that outlines the instances in which the evidence does  support induction of labor as a way to improve outcomes for mothers and/or babies.  This resource also defines the circumstances in which research is either inconclusive regarding the effects of labor induction or clear about the ineffectiveness or even harm of induction.

But without a medical indication for an early scheduled birth, there is the chance that a baby will miss out on the important fetal development that occurs up to and perhaps even beyond the 39th week of pregnancy.  This information is especially significant considering that many women are told erroneously by others (including some care providers) that babies “only gain weight” during the last weeks of pregnancy.

As a final note, it is also important to remember that unless an induction or planned cesarean is medically indicated, there are benefits to waiting for labor to begin on its own—even after the 39 week mark.  Induction and cesarean section at any time carry risks and thus should not be taken lightly by mothers or by care providers.  For unless otherwise indicated, waiting for labor to begin spontaneously is healthy for mothers, and it’s healthy for babies too!

Kristen Oganowski, CD(DONA) changed career paths from academic philosophy to maternity care advocacy after being utterly awed and inspired by the births of her two children: one born via cesarean, one born via VBAC.  Now she is a doula, blogger, aspiring childbirth educator, PhD candidate and mother of two in Columbus, Ohio.  You can find her speaking up for healthy pregnancy and birth on Twitter (@BirthingKristen), on Facebook, and on her blog, Birthing Beautiful Ideas

 

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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!


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