Everyone's eager to meet baby, but are elective inductions safe?

BlogHer Original Post

Elective inductions are on the rise in the United States, and while this means many excited mothers get to meet their babies sooner than if they waited for labor to begin spontaneously, it also means they are much more likely to meet their babies as a result of a cesarean section, which of course comes with it's own set of risks to both mother and child.

According to a study linked on Birthfriend's Place to Ponder:

In 2004, the National Vital Statistics Report showed the total induction rate (in the United States) to be 21.2%. Of that number, 25% were reported to have no apparent medical indication and were done for the convenience of either the patient or the physician (Martin et al., 2006). This rate represents a 9.5% increase since 1990. An even higher induction rate of 41% was found by the Listening to Mothers II survey (Declercq, Sakala, Corry, Applebaum, & Risher, 2006).

The desire to bring about the onset of labor is nothing new. Throughout history, women have tried to induce labor naturally through "home remedies" such as nipple stimulation, Castor oil, herbal remedies, sexual intercourse and more. As I neared the 41 weeks marker with my son, even I tried to naturally jump start labor by way of acupuncture to increase my chances of having a home birth. I went into labor that night. Had I reached 42 weeks, my likelihood of being legally allowed to have a home birth would have decreased.

The way I see it though is the difference between using natural means of inducing labor and medical means is the end result. With either one labor will begin only if the woman's body (cervix) is ready. However, with the natural methods, if labor doesn't begin, the end result is the woman is still pregnant and has to wait until her body is ready. With the medical/pharmaceutical means of induction, if labor doesn't begin or progress according to the care provider's timetable, the end result will most often be a c-section.

It is important to note that a woman should consult with her care provider before trying any induction method, even natural ones.

If you are leaning towards a medical elective induction, in addition to discussing your options and risk factors with your care provider, it is also important to do your own research and be an informed customer so you can make the choice that's best for the health of both you and your baby.

Although the American College of Obstetrics and Gynecologists recommends against elective inductions citing "Induction of labor is indicated when the benefits to either the mother or fetus outweigh those of continuing the pregnancy" (in other words, when medically necessary), many doctors are more than happy to accommodate a mom who is tired of being pregnant. Some doctors routinely do inductions at 40 weeks, even if "it's perfectly normal for 80 percent of healthy babies to have anywhere from a 38- to 42-week gestation" and even if a woman is not asking for it.

NedaAnn (AKA Iluvmysweetpea) who blogs at The unstable mind of an unhealthy body told me on Twitter that when she was preparing for the birth of her daughter four and a half years ago, she and the rest of the women in her childbirth class were told that at 40 weeks they would be induced. "We were told that at 40 weeks our fluid started to diminish, so it was a danger to baby. That's why we needed to be induced." On top of that, she said, her doctor who practiced at Albert Lea Medical Center in Minnesota told the class they use Cytotec for inductions. Having had done her research about the safety of Cytotec, she asked him about it and was told it was "not that bad." Her daughter Trinity came a month early, so she never had to deal with a possible induction, but NedaAnn believes, "Pregnancy used to be 42 weeks long, so why are we inducing at 40 weeks or before? I know there are legit reasons in a few cases, but overall it is a matter of convenience and I just don't think the risks are worth the convenience. And Cytotec should be banned."

The issue with Cytotec (misoprostol), if you are unfamiliar with this drug, is it has been FDA-approved only for treating ulcers, NOT for inducing labor. According to Marsden Wagner, MD, MS, "On the Cytotec label it is explicitly written that this drug is contraindicated for use on pregnant women." Using Cytotec to induce labor has many "serious adverse effects ... including maternal or fetal death, uterine rupture, and severe vaginal bleeding and shock." These risks are even greater if the woman is attempting a vaginal birth after cesarean (VBAC). According to an article on iVillage, "Cytotec's sole appeal is price. Cytotec costs pennies per induction, whereas Prepidil and Cervidil cost close to $100 per dose, and more than one dose may be needed. Cytotec also reduces the need for intravenous oxytocin (Pitocin), the hormone that stimulates contractions, another savings."

According to an article on CNN "Five Ways to Avoid a C-section," the number one way to avoid having a c-section to to get induced only if it's medically necessary and points out that first-time moms have a greatly increased risk of having a c-section after an induction.

One of the biggest risks of an elective induction is that it will, the majority of the time, end up in a c-section.

"If you decide to have an induction because your obstetrician is going out of town, or because your husband is going out of town, that may seem like a bona fide reason, but you'll pay the price with an increased rate in C-sections," said Dr. Michael Klein, emeritus professor of family practice and pediatrics at the University of British Columbia, who's studied C-sections.

Klein says studies of first-time moms show that 44 percent of those who are induced end up with a C-section but that only 8 percent of those who go into labor spontaneously end up with a C-section. Doctors say many times, inducing women way before the cervix is ready can lead to unproductive labor, which then necessitates a C-section."

A labor and delivery nurse who blogs at At Your Cervix says in her post Inductions Galore, "My last few shifts at work have been a wide variety of patients. Inductions that go no where, inductions that take off super fast and precipitously deliver, pretermers, preeclamptics, c-sections. I think I've done it all in the last few shifts. What bugs me are the inductions. These docs really dig for reasons to induce." And then she details the list of reasons doctors will induce. Then she also adds, "Then again, we have some docs who refuse to induce for made up reasons."

While many women may not have heard of this, there is a tool that helps care providers assess a woman's likelihood of having a successful induction - it's called the Bishop or Bishop's score. According to Revolution Health: "For the purpose of inducing labor with medicine, the Bishop score helps a health professional assess a woman's physical readiness to progress through vaginal delivery. The Bishop score is a rating of how soft, open, and thinned the cervix is (dilation and effacement), as well as how low in the pelvis the cervix and baby are positioned.

Bishop scores range from 0 to 10. The higher the number, the more likely a vaginal delivery will be successful. "

Want to know if you are ready for induction? You can even take an interactive quiz online that will assess the readiness of your cervix.

Jennifer Block at Pushed Birth discusses Why Not Schedule It?

What will an induction mean for you? If you induce, you’ll be admitted to the hospital and will most likely spend the next 24 hours of labor confined to bed. Because staff will need to kickstart and maintain contractions and dilation with drugs like Pitocin, Cytotec, and Cervidil, they will require IV fluids and continuous fetal monitoring. At that point you’ll very likely want an epidural, because Pitocin contractions are more painful, especially when you can’t move around. A director of OB/GYN in New York City called Pitocin without an epidural “cruel and unusual punishment.”

Jennifer adds:

If you’re considering a medically unnecessary induction, think about whom it will really benefit. While it may seem more convenient to just book it, think of the inconvenience of recovering from major surgery, or waiting for your baby to be released from a NICU — two very real possibilities. And think also about the increased risk to your pelvic parts of a pushed birth. Again, the best, healthiest option for both you and your baby is labor that your body starts on its own, progresses on its own, and concludes on its own terms.

Although there is a lot of information out there against elective inductions, there are legitimate reasons why a woman would opt for one. Christine from Watch me! No, watch me! (a woman who graduated from medical school just a month before her son was due) decided on an elective induction at 41.5 weeks. She had contracted PUPPP (Pruritic Urticarial Papules and Plaques of Pregnancy) at 38.5 weeks, which, in her own words, is "a HORRIBLY itchy rash that is covered in hard plaques. So, you're itchy but can't even get any temporary relief from scratching because of the hard top layer (gross, I know). Worse than that, the hard plaques themselves irritate the underlying rash. It was a nightmare. I couldn't wear clothes and even sitting down was and excruciating mix of unbearable itchiness and pain." By 41+ weeks, the rash had spread everywhere except her face and breasts and she was unable to sleep for more than two hours at a time.

The only thing that cures PUPPP is delivery, so at 41.5 weeks, Christine asked to be induced. After considering her condition and that she was getting weaker and weaker from lack of sleep, her doctors agreed to it. Due to her son being posterior, she was unable to progress past 6 cm, and decided along with her doctor that a c-section would be best, which Christine had a very positive experience with.

Christine notes that because of her medical background she was "a very well-informed patient." She adds, "I knew what was going on from start to finish and this is the route I chose."

Sheridan at Enjoy Birth Blog believes there are Five Good Reasons for an Induction, as well as Five Questionable Reasons for Induction, and Five NO Risk Alternatives to Inductions.

I've personally given birth to two children - one was medically induced with Pitocin due to my developing HELLP syndrome at 39 weeks and the other labor began on it's own (well, after a round of acupuncture the night before). The difference in the two labors was very noteworthy. When I was induced with Pitocin, my contractions quickly became nearly unbearable and I felt I had no breaks in between them. They just kept hitting me over and over. With the induction I was also restricted to laboring in bed, which I feel inhibited my ability to effectively deal with the pain. Even though I had no intention of having an epidural when I went into it, I quickly changed my tune and asked for one but was denied it due to my falling platelet levels, so I had to cope with the pain in other ways. With my labor that began naturally I was able to move about freely and change positions. The pain never became unbearable. In fact, it only got really uncomfortable in the last hour or so, but was still manageable, as opposed to my medically-induced labor that was uncomfortable and borderline unbearable for hours. Both labors lasted around 12 hours, but the differences between the two were unforgettable. I'd never choose to be induced again unless (again) I had very good reason for it. I can't imagine putting my body or my baby through that without good reason.

Additional resources:
- Mothering magazine: Let the Baby Decide: The Case against Inducing Labor
- CYTOTEC petition: Cytotec (misoprostol) for Labor Induction Consumer Awareness
- From Henci Goer, author of The Thinking Woman's Guide to a Better Birth: Elective induction of labor - "Is elective induction safe and effective?", "Who makes a good candidate for elective induction?", and "How can women considering elective induction minimize the risks?"
- From Descent to Truth. To Life. To Birth. To Motherhood.: Stop the Misuse of Cytotec to Induce Labor


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