What You Need To Know To Avoid Unnecessary Induction

Labor induction at 39 weeks is being suggested by obstetricians more and more for healthy women having normal pregnancies.

Although there are certainly times when induction is absolutely warranted (hypertension, preeclampsia, gestational diabetes), there are times when it can be questionable (due dates, large baby, maternal age).

If a mom needs to be induced for the safety of herself and or her baby we are so lucky to have the technology that we do now to be able to do it in a controlled environment where safety precautions are in place.

What I’m writing about here is meant for mom’s who are healthy, have had a completely normal healthy pregnancy and baby and yet their doctor is encouraging them to induce early.

My aim is to help those mom’s understand why their doctor is suggesting induction and to help them have the resources they need to figure out what is best for them if they are feeling uncertain about induction.

Too many inductions are happening for non medical reasons, leading to long and difficult labors with long and difficult recoveries for no good reason.

On the other hand I am NOT talking about women who have a medical condition that means going to or past their due date can be harmful or life threatening to them or their baby.

I never want to contribute to the already contentious mindset of women in our society that says only one way of doing things is the right way and you’re not good enough if you don’t do it that way.

What’s the deal with induction…?

Risk VS. Benefit Or Just Risk Adverse

What can you do to avoid unnecessary induction? First, we need to understand that doctors are always coming from the mindset of minimizing risk.

They make decisions based on the question, “How can we reduce the possibility of an adverse outcome”?

Of course we want to do the things that will minimize the risk of possible negative outcomes. However, it is impossible to eliminate all risk in childbirth.

No matter how many variables you account for there are still things that can happen that never could have been predicted.

In order to reduce the risk as much as possible, policies and procedures have been put into place to protect the large majority of birthing women from experiencing birth/fetal complications.

All of this sounds good, right? Yes and no…no because doctors have decided that it’s okay to induce moms at 39 weeks because they can possibly control for certain risks that way.

Before her body is ready. Before her baby is ready. Induction increases the chance that a woman will have cesarean surgery because the labor fails to progress.

The act of trying to reduce risk by inducing healthy women at 39 weeks may be causing more harm if the risk being avoided was never going to come to pass in the first place.

The trouble with focusing solely on reducing risk for labor and birth is that it is so unpredictable and every mother and baby dyad is different.

What Are The Reasons For Induction

A few of the more troublesome ones that my clients find themselves facing often include, due dates (discrepancy between what mom states was her last cycle or her cycle in general and what the ultrasound shows), suspected large baby and advanced maternal age.

The main thing to understand here is that the concerns that these reasons lead to are legitimate concerns but they are most certainly not going to happen to EVERY woman who goes past her due date, or EVERY large baby or EVERY woman who is 35 and older.

Many times mothers will know the date when they conceived or they know that their cycle is 25 days instead of the typical 28 days but doctors state the due date as 40 weeks from the first day of her last menstrual cycle regardless.

Ultrasound and growth scans are far from perfect in determining baby’s size and weight.

Many times I have supported moms through early inductions due to a suspected large baby to have the baby weight a very average 7 pounds at birth.

What Information Leads To The Policies

There are numerous studies that doctors use to base their reasons for induction on. Many times they lead to more questions rather than answers.

You can find most OB policy guiding studies and the analyses of them on the birth research website Evidence Based Birth.

Her article about early induction for due dates can be found here and her article on early induction for a suspected large baby here.

Evidence on advanced maternal age here.

So the question becomes, is preventing the risk of negative outcomes from being overdue, possibly having a large baby or being 35 or older, worth the possible negative impacts of inducing early?

I’m going to get to that answer but first we need to look at another troublesome problem. The ACOG states in answer to the question,

“Are there other reasons to have labor induction?

Yes. In addition to some conditions for which labor induction is recommended, new research suggests that induction for healthy women at 39 weeks in their first full-term pregnancies may reduce the risk of cesarean birth.“

The new research they are talking about is called the ARRIVE study.

Its findings suggest that healthy women can be induced at 39 weeks to experience fewer c-sections and babies might be slightly better off if routinely induced at 39 weeks.

It turns out that there are some very large discrepancies in this new research as Henci Goer concludes in her article on Lamaze.org.

There are more questions than answers left behind from this study and the results of a few slightly better outcomes and a few less c-sections does not outweigh the disadvantages of inducing unnecessarily.

The goal was to see if the women in the study who were not being induced would have less cesareans.

Because even before this study there was the problem of too many unnecessary inductions happening and I guess they wanted to see if that was one of the contributing factors to the high c-section rates.

The study showed that trying to minimize inductions with the hope of preventing cesareans may be misguided.

Okay, great, but the logical conclusion to this study should not then be, well, let’s just induce all healthy women at 39 weeks then!

I am surprised that the study did not show more women having cesareans as a result of being induced because historically that is what has been shown by other studies,

…In contrast, numerous population studies, which look back at what happened in a large group of mothers, have reported higher caesarean rates when labour is induced. These studies typically show the caesarean rate to be twice as high when labour is induced.^9,10,11,12

Nadia Higson. Full article here.

I can tell you one thing for sure that this study did not cover and that is… Did these induced women have a good, satisfying and fulfilling experience of their labor?

Last year my then pregnant neighbor, who is a physician assistant and so very comfortable in the world of medicine, told her OB about her concerns that her husband may only have a few days to be home after her due date because of a previously arranged work trip to Japan.

Her OB told her about the ARRIVE study and that, no problem, she should just induce early and therefore know when baby is coming and have the extra days with her husband.

My neighbor being very anxious about her husband and trusting of the medical provider agreed.

She did not have very favorable conditions with her cervix so the induction was very long and slow and uncomfortable taking two days just to get into labor.

The labor failed to progress and she had a c-section. She was really disappointed.

She fully believed that inducing would not be any worse or more difficult than waiting for labor to begin on its own.

She thought she was solving her problem but instead it created a much bigger problem!

Pitocin, which is a synthetic version of the hormone oxytocin, will make contractions happen.

Whether or not those contractions will actually change and dilate the Cervix is a different story. Pitocin works on the uterus, NOT the cervix.

It makes the uterus contract but sometimes without your bodies oxytocin flowing you will not actually go into labor.

Labor is the process of the uterus’s contractions causing the baby to move down and apply pressure to the cervix thereby dilating it.

The cervix first needs to be soft and pliable in order to dilate and that happens as a result of prostaglandins and oxytocin being released.

Contractions alone do not make the whole story of labor.

As Pitocin is increased it will make the contractions come closer together which is also a necessary component of labor.

However, it cannot adjust for the intensity or strength of the contraction or the efficiency of the contraction as your own oxytocin can.

What can happen is that you get lots of contractions coming and possibly no change of the cervix.

This is discouraging and difficult to deal with.

Pitocin then is turned up to the level it needs to be to make cervical change and the contractions come very close together.

Not being able to get a break and feeling like you are having just a never ending contraction is challenging to deal with.

Sometimes baby’s don’t tolerate the higher doses of Pitocin well and may experience distress which if not resolved a cesarean may be necessary.

What Can You Do To Avoid Unnecessary Induction?

Ask LOTS of questions. If your OB is suggesting inducing labor early and you feel uncertain about it ask questions!

Is there a medical reason you are wanting to induce? What are the risks/benefits?

What other options can you offer?

What are the implications of waiting until I go into labor naturally?

What is the scientific data that you are using to base this decision on?

Present the information that you find at Evidence Based Birth at your appointment and discuss it with your provider.

Let them know that you have done your research and you want a real discussion about your own situation and how it pertains to the research.

Find A New Provider

If doing the steps above does not provide a resolution that you are happy with then it might be time to find a new provider.

I will say this many times throughout various places on this site, certified nurse midwives beautifully handle normal deliveries and it is wise to consider their services if you wish to avoid unnecessary medical intervention for your birth. They deliver in hospitals. Find them!

This article from Reuters talks about the benefits of having midwives and obstetricians working cooperatively but with the majority of normal deliveries going to the midwives and those with complications being handled by OB’s.

Midwives do not look at birth from such a risk adverse approach as doctors, possibly because they are not sued at the same rate as there OB/GYN counterparts.

They start with the idea that birth is a normal, natural physiological process and women are capable of doing it, even if the baby might be large or the mom is 39.

There are always OB’s on call at the hospital ready to step in if something more serious is needed.

If you are feeling pushed into something you are not sure about or your doctor is not hearing your concerns and questions I strongly encourage you to find out if there is the opportunity for you to have midwifery care at your hospital or perhaps another nearby hospital.

For a FREE 30 minute consultation about doula services in Portland or virtual or for my private individualized birth preparation focused on your goals and desires please fill out the form below.

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Laboring At Home: How To Know When You Should Go To The Hospital