Labor Inductions - Part II

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?

Nov 14, 2006

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.

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.

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.

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:

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.

Jun 8, 2009 1:34 PM

Guest :

I found this article a fascinating read but it does not take into account the necessity of being induced from a strict medical point of view. I was induced at 41 weeks and a day. After 13 hours of induced labor, my baby weighed in at 9 pounds. It was very obvious from the placenta that it was breaking down and would not have been able to support my baby for much longer. How long should I or my gynecologist have waited to decide the final course of action? Believe it or not, I think this was the best decision made given the circumstances at the time because I would rather be induced than have a caesarean. I am 36 weeks pregnant with my second child and so far she is within the acceptable growth curve but the next few weeks can be tricky if she suddenly gains a lot of weight.

Jul 15, 2009 8:05 AM

Guest :

I was improperly induced for my first pregnancy, I thought my water had broke at 39 weeks how ever the nurse was unable to determine if my leakage was really ambionic fluid. They kept me in the hospital, stuck a monitor on me and dosed me with pitocin. Over 12 hours later stuck in a bed I was not diliated and they gave me demerol for the pain. At the highest allowable does of pitocin and after 23 hours of labor my baby finially came into the world. Needless to say, I believe the contractions were out of control, and way more painful then what other women have described. I wish I had known more then, I read books and thought I was prepared...I am 39 weeks now with my second, this time I am waiting until my contractions are a few minutes apart before running to the hospital.

Sep 4, 2009 6:39 AM

Guest :

I was induced at 37 weeks due to pre eclampsia because my blood pressure wasn't responding to medication. I was given the gel then a few hours later my waters broke and slowly I went into labour. Within about 4 hours of established labor I had still only progressed to 1 cm dilation and the doctors were talking of caesarian. I absolutely refused believing 4 hours to be too early to give up as bubs and I were fine. In the end I had a caeser after about 14 hrs of labor where they pumped me full of everything they could to try n speed things up, I had only reached 2cm! At the time I felt they wanted me to have a caeser so I didnt interrupt the drs golf game if I had an emergency, and for a long time I felt that my caesar may have been unnecessary. After reading this article, I finally feel as if they did the right thing by me from start to finish. This is very reassuring as I'm now 36 weeks with my second and was planning a vbac. 2 days ago I found out bubs is breech so now it's all up in the air. At the end of the day it doesnt matter how we have our babies as long as they are okay, but noone should have to have unecessary surgery. It is a big relief to me now to feel that my intervention was absaolutely necessary..