Labor Induction: Exposed

14 Jan

Although there is no evidence to show that non-medically indicated inductions improve outcomes for babies, inductions for non-medical reasons have been on the rise in the U.S. Increasingly, labors are being induced for psychosocial reasons and for medical convenience. What’s more, the majority of expectant mothers are not aware of the risks of elective induction when they request one or when their caregiver schedules it.

We are learning, however, that with a healthy pregnancy, not waiting until labor starts on its own may have far greater health consequences for babies than we knew. Research shows that when births are induced or cesarean sections are scheduled — especially before the 39th week of pregnancy — newborns may appear mature, but they are at greater risk for short- and long-term complications.

Labor Induction: Alarming Statistics

In 2005, 22.3 percent of all U.S. births were induced — a 50 percent increase since 1990. A  national survey by Childbirth Connection (Listening To Mothers II) showed that 21 percent of U.S. women who gave birth in 2005 tried to self-induce labor because they were tired of being pregnant. They wanted to induce to avoid a medical induction, to control the timing of their birth, or because their caregivers were concerned about the size of the baby.

Elective induction rates vary widely among hospitals (12 percent to 55 percent) and among individual physicians (3 percent to 76 percent). More than four out of 10 mothers (41 percent) in the Listening To Mothers II survey reported that their caregiver tried to induce labor. For some women, an elective induction can almost double the risk for a cesarean, depending on the individual physician’s practice style and medical specialty. And all of these statistics are even more frightening when compared to the World Health Organization’s recommendation that appropriate induction rates in any geographic region should not exceed 10 percent.

Labor Induction: The Risks

With an elective induction, babies are more likely to suffer from hypoglycemia, to be admitted to a special care nursery, and to need ventilator support. A recent study of a U.S. healthcare system showed that babies born at 37 weeks were 22.5 times more likely to need a ventilator at birth, and babies born at 38 weeks 7.5 times more likely, when compared to babies born at 39 weeks. Babies born too soon are also more likely to experience serious complications, including fever, infection, respiratory distress syndrome (RDS), and transient tachypnea of the newborn (TTN). These babies may look normal, but have an increased risk of difficulties with vision and hearing, feeding and digesting their food, regulating their body temperature, and are more likely to need phototherapy to treat jaundice.

The newest research on babies born before term indicates the potential for neurological problems and learning difficulties that may not show up for years. The March of Dimes is educating healthcare professionals and mothers alike about the important brain growth and fetal neurological developments that take place in the  very last weeks of pregnancy. At 35 weeks, a baby’s brain weighs two-thirds what it will weigh at 39-40 weeks. At 37 weeks, the brain weighs only 80 percent of its weight at 40 weeks. The cerebral cortex — the part of the brain that controls functions such as cognition, perception, reason and motor control — is the last to develop. Researchers have found that babies born pre-term are more likely to have learning difficulties at school age. It’s essential for baby’s brain development that the pregnancy goes to full-term. The March of Dimes and the  U.S. Surgeon General’s Office has launched an educational campaign to educate expectant families that a full-term pregnancy is 40 weeks and that an early elective induction has serious risks. Vice Admiral Regina Benjamin, MD, MBA, Surgeon General of the U.S. is featured in several public service announcements speaking to expectant mothers about the health benefits of a full term pregnancy.

Labor Induction: Consider This

An induction of labor is a complex process that often requires additional medical interventions to keep the mother and baby safe from successive potential complications. Inducing labor with pitocin when the cervix is unripe (long and closed) sometimes causes the mother to labor for long hours with little progress. Subsequently, confining the mother to bed, using continuous fetal monitoring and IVs, and administering an epidural for pain are commonplace with an induction. Shoulder dystocia (when the baby’s shoulders cannot fit through the pelvis), and the use of forceps or a vacuum extractor are also increased with induction. All of these interventions and complications can lead to higher risk of cesarean section — failed inductions are not uncommon.

Labor Induction: When it’s Helpful

Regardless of all the risks, there are several medical indications for inducing labor — when the mother or the baby’s health would benefit more from the induction than from continuing the pregnancy. These may include diabetes, pre-eclampsia (high blood pressure), or a uterine infection in the mother. Or when a baby in utero is not growing at a normal rate (small for gestational age) or the pregnancy is post-term (more than 42 weeks). Induction may also be favorable when the bag of waters breaks prematurely (also known as PROM, premature rupture of the membranes).

Labor Induction: Questions to Ask Your Provider if it’s Suggested

  • Why are you scheduling an induction of labor?
  • What are the risks of inducing my labor?
  • I know that my due date is only an estimate. What precautions will you take to make sure my baby is not born too early?
  • How do you plan to induce my labor?
  • How will an induction affect my labor and the health of my baby?
  • I know that compared to waiting for labor to begin on its own, an induction is more likely to lead to a cesarean section. What measures would you take to reduce my odds for a cesarean?

If both you and your baby are healthy and stable, don’t hesitate to take time to consider your caregiver’s recommendations and explanations. Feel free to leave the appointment, with a follow-up scheduled — or to get a second opinion. After all, this is your birth.

The last week or two of pregnancy may be difficult. Priorities at work, or scheduling maternity leave to accommodate childcare or family needs may be a priority. However, waiting for labor to begin on its own is safer for you and your baby — and safety is of the utmost importance!

Other resources:

Childbirth Connection, What You Need to Know about Induction of Labor

March of Dimes/CMQCC Toolkit, Elimination of Non-medically indicated (Elective) Deliveries Before 39 Weeks Gestational Age. California Maternal Quality Care Collaborative

Maternal and Neonatal Morbidity Among Nulliparous Women Undergoing Elective Induction of Labor
Authors:     J. H. Vardo, L. L. Thornburg and J. C. Glantz , Journal of Reproductive Medicine

This article was first published on the Mother’s Advocate Blog on November 15, 2010.  See  the video, Let Labor Begin On Its Own, at the end of the article.

3 Responses to “Labor Induction: Exposed”

  1. Lisa Goodin (Evans) December 31, 2011 at 11:43 am #

    For years i have struggled with the fact that my middle child had a learnng dissability. Trying to find a reason for it. Now after reading some of the evidense, i realise it was the induced birth. She was behind talking, tying shoes, and when she was learning letters it was impossible to teachher. Also she had problems as an infant that i never realised were connected. She could nurse a breast dry, then regurgitate almost all she consumed and be hungry still. Do the same on the other breast and still be hungry. I was told some babys do that. Feeling i wasnt able to provide for her i put her on formula that could provide an endless source. I now realize this could have been a digestive problem as a result of being an induced birth. Just a note ; her birth was induced because i lost part of the cervical plug and was leeking amnio fluids for 24 hrs prior. So i didnt have a choice ( as far as it being a convenience. I was thrilled about that). But i regret that now.

  2. Jim Nicholson August 3, 2011 at 6:28 pm #

    No evidence that “non-indicated labor induction” improves neonatal health (and maternal health)? Really? Consider the HUP-POP randomized clinical trial (published in AJOG) that is one of the few randomized clinical trials that has examined this question……it found the a higher rate of labor induction caused a statistically significant reduction in NICU admission rate, a statistically significant reduction in AOI score (adverse outcome index score) and a statistically significant increase in rate of uncomplicated vaginal birth. Isn’t that what we are all after? And these findings are consistent with the findings of several retrospective studies of AMOR-IPAT (the active management of risk in pregnancy at term). The impact of labor induction on c/s rates and neonatal outcomes has not been adequately studied – but just about everyone is more comfortable just believing that labor induction is necessarily a bad thing. What if that assumption is actually wrong?

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