The Best and Worst Reasons to Induce Labor
Although few true reasons to induce labor exist, labor induction is rapidly becoming the norm in many places. At present, 1 in 5 labors are induced. This is alarming to say the least. Let's start with some of the worst reasons to induce labor:
OVERDUE
PREGNANCY
One of the most commonly-cited reasons for induction is an overdue pregnancy. However, this can be a very arbitrary statement. Does the baby know it's overdue? They don't know when they're due, but they do know when they're ready. Even with all our advanced technology, doctors *still* don't know exactly what causes labor to begin. They can artificially trigger it, but not in the same way as a woman's body.
The American College of Obstetricians
and
Gynecologists (ACOG) recommends against elective induced labor before
39 weeks gestation. However, this is a liberal statement in that the
average duration of pregnancy worldwide is actually 42 weeks.
Quite a difference, especially when some doctors will start discussing
induction at 36 weeks!
Another issue to consider is the
accuracy of the "due date". Most pregnant women have seen the
"pregnancy wheel" at one
doctor visit or another. You know, it's the little circle that they
twist around to tell you your due date.
The main flaw in this system is that it calculates your due date based
on the first day of your last period and assumes that every woman has a
28-day cycle and ovulates on day 14. If you have long or irregular
cycles and ovulate late, this date can be significantly off. Unless you
are actually using charting or some other method like the clear blue
easy fertility monitor, you won't be able to pinpoint your ovulation
which makes your due date even sketchier. Being pas your due date can
be one of the arbitrary reasons for inducing labor.
A reliable estimate of the due date can be obtained via a transvaginal
ultrasound between 8-10 weeks of gestation. This measurement is far
more accurate than the good ole pregnancy wheel. This type of
ultrasound should give a due date with an error rate of +/- 1 day. It's
important to note that as your pregnancy progresses, ultrasound becomes
a less reliable predictor. A late term ultrasound should never be used
as one of the reasons to induce labor, to change a due date, or to
predict that a
baby is too large. At that stage of the game, the error of measurement
can be off by as much as 2 pounds in either direction. The only caveat
would be if regular ultrasounds have been conducted that show a clear
pattern of rapid growth.
THE BABY IS TOO BIG
If I had a nickel...The truth is that there is absolutely no way to tell whether or not a baby will fit is until you are laboring. This much-overused of reasons to induce labor should frequently not be a reason at all. When in labor, hormones are excreted that make your hips, pelvis, and all the tissues relax. When it relaxes, it stretches. Even your hips widen. Remember, your body was made for this. It knows what to do. How many other mammals cannot give birth naturally because their babies are too big? They were designed for birth, just like us.
I'M TIRED OF IT ALL
Don't even get me started! A woman I worked with once said that to me. Did I have to bite my tongue! This should definitely not be one of the true reasons to induce labor.
So you're uncomfortable and tired? Too
bad! Isn't a
little discomfort worth the health and well-being of your child? I
think it should be. Once you hold that baby, all the woes of pregnancy
will be over.
In other cases, a family may elect to
schedule an
induction because it's convenient: out-of-town family will be there,
the medical provider is available, etc. Are these truly
reasons to induce labor? Sometimes making the right choice is
inconvenient. Do it anyway.
So now that we've covered some of the worst reasons to induce labor, let's look at the best.
PRE-EXISTING MATERNAL HEALTH CONDITIONS
If the mother has health problems such as heart disease, a seizure disorder, hypertension, cancer or any other serious medical condition, induction may be indicated. However, many women with some of these conditions give birth naturally.
If you have a potentially life-threatening condition, then discuss your
options with your care provider.
PRE-EXISTING BABY HEALTH CONDITIONS
In some cases, a family may know that their baby has a congenital condition which requires intervention or special care at birth. In these cases, the controlled environment of an induction may be one of the reasons to induce labor.
Are there any circumstances that prohibit an induction?
Yes. You'll need to have a c-section whenever it would be unsafe to deliver vaginally, including the following situations:
- You have a placenta previa, you have a vasa previa (when blood vessels from the umbilical cord are embedded in the amniotic membranes and at risk for rupture during labor), or the cord is lying in front of your baby's head and could be compressed as his head enters the birth path or prolapse through your cervix when your water breaks.
- You've had more than one c-section. (Some doctors believe that women with even one previous c-section shouldn't be induced.)
- You had a previous c-section with a "classical" (vertical) uterine incision or other uterine surgery, such as a myomectomy (surgery to remove fibroids).
- You're having triplets or more.
- You have an active genital herpes infection.
How do you know if your body is ready for induction?
As highlighted previously, no method of induction is guaranteed to be successful if the cervix is not ripe. This can often be a factor in an induction that turns into a failure-to-progress c-section. A guide that is commonly used is the Bishop's score.
A Bishop's
Score refers to a group of
measurements
used to determine whether a woman's cervix is ripe for induction. The
Bishop's score alone should never be used as one of the reasons to
induce labor. The Bishop's Score is based on baby station, dilation,
effacement, position and consistency. A score from 7-10 is most
desirable when considering induction.
The truth I have seen lately is
inductions with
scores as low as 2, which makes success rates low. This far too often
leads to cesarean births. The following chart illustrated the
percentage of cesarean sections after failed induction as related to
the Bishop score.
Here is a chart to help you calculate your Bishop's score. But remember a high Bishop's score in itself is not one of the reasons to induce labor. It does not mean you need an induction. It is simply a measure of whether or not the labor induction would likely be successful.
Make
informed decisions for both you
and your baby!
If you are below a 7, less than 41
weeks, and not
experiencing any health conditions, let that baby cook.
Make sure you have a one of the true reasons to
induce labor before you consider it. As the end of your pregnancy
nears, remember that no woman stays pregnant forever. That baby will
arrive in the end.
Good things come to those who wait.
References
Gülmezoglu AM, Crowther CA, Middleton P. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD004945. DOI: 10.1002/14651858.CD004945.pub2.
Dodd JM, Crowther CA. Elective repeat caesarean section versus induction of labour for women with a previous caesarean birth. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD004906. DOI: 10.1002/14651858.CD004906.pub2.Irion O, Boulvain M. Induction of labour for suspected fetal macrosomia. Cochrane Database of Systematic Reviews 1998, Issue 2. Art. No.: CD000938. DOI: 10.1002/14651858.CD000938.
Harman & Kim. "Current Trends in Cervical Ripening and Labor Induction" American Family Physician 1999; 60:477-84.
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