Inducing Labor- the pros and cons

As the due date approaches, something strange happens. The pregnancy that seemed to fly by so quickly suddenly drags. Days seem to stretch on forever, and it seems as though baby will never arrive. Taking into account that most first time mothers will gestate well past the estimated due date, this time of limbo can be particularly frustrating. An option that is often presented to mothers who have reached term (redefined by the ACOG to be 39 weeks as of 2013) is a medical induction. There are many methods of induction, which I will tackle in a later discussion. Today we are talking about induction as a whole, and the pros and cons.

An induction can seem like a beacon of warm light to an impatient mother, beckoning her to the end of her pregnancy and birth of her child. It seems like the perfect solution- you can set a date, there is no guesswork involved {a la "was that just pee or my water breaking?", "are these contractions real?" "is it time to go in!?"}, and you can schedule your time around your induction. You can make sure family and friends are there and available, and you can pick the day you want, avoiding those pesky holidays or other family birthdays. If you have older children, you can pre-arrange childcare and make sure everyone is ready for the arrival of the new baby. You can make sure you are well rested the night before your induction {HA! who can actually sleep when you know you are meeting your baby soon!?} and have all the essentials ready to go. All of this seems wonderful, right? It's the perfect answer to your impatient, super-pregnant prayers!

But wait. There's more.

Induction is the artificial stimulation of labor, and with anything artificial, there are side effects. The most common method of induction is Pitocin, which is a synthetic form of Oxytocin which your body naturally produces during spontaneous labor. This drug causes your uterus to contract and essentially forces baby out. Labor by induction is more painful than spontaneous labor because your body has not had appropriate time to establish a contraction rhythm. The Pitocin quickly gets things moving and puts your body into high gear, often before it is prepared. This can have many effects on the body, and on your baby. Common side effects of an induction are fetal distress, 'failure to progress' resulting in cesarean, umbilical prolapse, premature birth, hemorrhage, and of course, the cascade of interventions. I will also be talking about the cascade of interventions as it applies to all types of labor at another time, but induction is a major leaping point for that cascade. The greatest risk of an induction is a cesarean birth- being medically induced doubles your likelihood of undergoing a surgical birth.

In some cases, an induction is medically advised. Situations such as preeclampsia, IUGR, previous post-term stillbirths, severe gestational diabetes, a gestational period of longer than 42.5 weeks, or a pre-existing medical condition of the mother or fetus are all reasons an OB may request an induction of labor. In those cases, induction can be the best choice for both mother and baby. It is always best to weight your personal pros and cons and discuss your medical needs with your doctor.

However, there is an instance where induction may be recommended but the grounds are not founded: the big baby. Often, women will be induced prior to the due date because "the ultrasound showed that the baby was huge". First, ultrasound measurements are notoriously inaccurate in late pregnancy. The weight estimates can be off by as much as 2 lbs. Many women are induced, expecting a huge 8 1/2 lb baby {that's actually a pretty average size} and then when baby arrives they are shocked to find he is in the 6-7 1/2 lb range. Second, the pelvis is not one single solid bone; it is designed to shift and open up, allowing baby passage. I've seen a tiny 5'3" woman birth a 10 lb 4 oz baby like it was nothing. The 'big baby' needing medical intervention for birth is a myth. Nine times out of ten, your body will not gestate a baby too large to pass through your birth canal naturally and without intervention.

Elective inductions are discouraged by the ACOG, due to the high volume of risks for both mother and baby. If it's not medically necessary, it is best to wait for spontaneous labor. Sabine Droste, MD, professor of Obstetrics and Gynecology at the University of Wisconsin-Madison says, "Induction is a medical procedure that carries risks, so it should be reserved for medical reasons only."

Along with the aforementioned risks, induction also usually goes hand-in-hand with an epidural. Because an induction is not natural, spontaneous labor, the body doesn't handle it as well and pain medication is usually required. The epidural brings with it a whole host of additional risks and side effects, most common being the labor stalls and often will be transferred to a cesarean. Other side effects include needing a vacuum or forceps assisted birth, difficulty breastfeeding, continued pain at the injection site, spinal headaches, loss of consciousness, and, most rare, paralysis.

Another thing to be aware of is that induced labors are notoriously longer than spontaneous labor. Inductions, on average, take 2-3 days, especially for first time mothers who are not yet 40 weeks. A few women get lucky and wind up with 8-12 hour inductions, but the truth is, the vast majority aren't that lucky.

While there are many, many cases of successful inductions, it is wise to be aware that approximately 50% of inductions do end in cesarean birth.  There are certainly pros to an induction, in that you have the luxury of choosing your labor day{s} and can plan around it. There are enormous risks though, and it is best if you are fully aware of all that an induction entails before choosing one. It is up to you, your partner, and your doctor to weigh your pros and cons and decide if a medical induction is the right choice for you.