Labor Inductions – Part II

Labor Inductions

What are medical reasons for inductions? Are inductions increasing the cesarean rate? What questions should you ask your doctor if he/she recommends an induction?

Medical Reasons for Labor Inductions

Labor inductions are medically needed in situations where the baby or mother’s health is at stake. The mother might develop high blood pressure late in her pregnancy or there might be a decrease in the amount of amniotic fluid that cushions the baby.

If the mother’s due date has passed and the tests performed on the baby are not reassuring, a labor induction is typically recommended. Clearly some medical reasons do require labor inductions. These high-risk inductions appear to be in the minority, however, since the above-mentioned 1999 Green Journal review reported that as many as 3 out of 4 labor inductions were performed without an indicated risk.

Are Labor Inductions increasing Cesareans?

Even with its convenience and necessity for high-risk mothers, experts believe that labor inductions are, in part, responsible for the increase in the cesarean rate. More time is spent in the hospital with a greater number of medical procedures required, which may, in turn, lead to an increase in cesareans. One of the biggest factors that affects whether the mother has a vaginal or cesarean birth is if her body is ready for labor. Her cervix should be “ripe” (soft, effaced and dilated) prior to an induction.

If the mother’s cervix is not ripe, it increases the amount of pitocin used in the induction and the length of her labor; both of which can make the labor more stressful to the baby. In fact, a 2006 study in the Green Journal reported that even when women used “cervical-ripening” agents to get their cervix ripe for a labor induction, they still had a higher chance of a cesarean.

The Effect of Labor Inductions on the Baby

One of the most significant problems with inductions is unintended prematurity. If the mother is induced 2 weeks early and her dates are slightly off, the baby might actually be born at 37 weeks’ gestation. Babies that are pre-term will have a harder start in life. They can have more difficulty in breathing on their own and often require a longer stay in the NICU (Neo-natal Intensive Care Unit.)

Because the pitocin used for labor inductions can cause more powerful and intense contractions than spontaneous labor contractions, babies need to be monitored continuously for any signs of distress during an induction. In fact, inductions are more likely to cause fetal distress.

The intensity of contractions during a labor induction can also make it more difficult for mothers who are planning a natural birth to avoid using pain medication.

The Pros of Spontaneous Labor

While labor inductions can be helpful for the high-risk mother, there are several advantages to waiting for labor to begin naturally. Mothers have the ability to labor at home more comfortably. They have freedom to use various positions during labor and can eat and drink what they desire. Labor may feel longer if the mother is at the hospital from the very first contraction. If she labors at home and arrives at the hospital in active labor, it often seems shorter to her than a labor induction.

In fact, mothers are typically much more able to tolerate a very long labor by spending time at home rather than laboring at the hospital the whole time. Resting and conserving energy may also be easier without the noise and disruption of hospital staff and procedures. And, as previously discussed, babies generally tolerate spontaneous labor contractions better than those from a labor induction. Spontaneous labor also has the advantage of reducing the mother’s need for a cesarean, as well as other medical intervention.

Another advantage to spontaneous labor is freedom of movement and use of a greater variety of pain relef techniques for labor. Mothers are able to move about, shower, take a bath, walk around the labor floor and in general change positions much more easily than if they are restricted to the bed attached to IV’s with continuous monitoring.

Becoming Educated Consumers about Labor Inductions

In cases where there is no medical reason, mothers are encouraged to ask questions to their providers. Here are some helpful questions as a guide when considering an induction or when one is recommended to you:

  • 1. Is there a specific medical reasons or indicated risk(s) for me or my baby for a labor induction?
  • 2. Do I have the option of waiting for labor to begin on its own?
  • 3. Are you comfortable if I use various ways to stimulate labor before or instead of a labor induction? (nipple stimulation, castor oil, acupressure/acupuncture, herbs)
  • 4. If I need to use pitocin, can I have the following options: reducing the concentration level, increasing the intervals between dosage increases or turning down the pitocin with stronger contractions?
  • 5. If I am induced early, what is the likelihood that the baby would need to be in the NICU?
  • 6. Can I use a portable/telemetry monitor to increase mobility during a labor induction?It is important that parents take the time to discuss all of their options with their provider before any procedure is recommended.

Would you consider being induced without a medical reason? Why or why not? Share your opinion.

Be sure to read Part I of this article, including why women may choose inductions and what percentage of mothers have labor inductions today.