The Birth Pro

Practical Wisdom for Today's Growing Family

To Induce or Not to Induce?

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baby with booksInduction is a topic that I have spent a bit of time researching as I have never had a baby with a pregnancy last shorter than 42 weeks 2 days and my longest was 43 weeks and 4 days. So it’s come up each and every time. And each and every time I have a competent care provider working with me to make sure that we are both healthy and sound.

While induction certainly has it’s place and no-doubt has saved lives, it should not be gone into lightly and the choice between inducing or waiting for labor to start on it’s own should not be treated like the option between Coke and Pepsi. There are many risks and true medical concerns with induction, especially when it is unnecessary that are often far overlooked. I wrote this post because I am not anti-induction. I am just pro-being-SAFE. 

The biggest issue with the medications used for induction is that they are artificial. Foreign to the body. When a woman goes into natural labor it is HER BODY, in tandem with the baby, is what is regulating the oxytocin levels that cause contractions. This means the body can make sure that they are not “too much” for the baby to handle. But if you hook yourself up to a mechanical pump that distributes the drug, which is the case for Pitocin (or “artificial oxytocin”) or worse, take a pill either orally or vaginally (Cytotec or misoprostol) that has no ability to be shut down except with other medication, then you are in a position where the mechanical or artificial means are not naturally “in tune” with the needs of your body and your baby. And therefore cannot naturally and subtly adjust accordingly like our amazing bodies can.

ScalesNow, if the baby needs to be born right now for a variety of very legitimate reasons, then all of this information and these risks are looked at through a different light. If you have a very real threat, then of course it is still just as important to be well informed, everything is just shifted into perspective as it is now weighed against the other side of the scale. But if you’re talking about a healthy baby and a healthy mom, then without the weighted balance of a good reason for induction placed on there, the risks start looking very big and disproportionate to just, well… waiting.

Some of the needs that can be overlooked are:

  • Is the baby ready to come?
  • Will the contractions be too strong for the baby to tolerate?
  • Will the contractions be too strong for the mother to tolerate?
  • Does there need to be a break in contractions for a time so mom can rest or baby can get in a better position?
  • And more…

I’ve attended many inductions as a doula and have seen a good number of them work out very well! Mom felt like she could physically handle/endure the contractions and baby seemed to fair very well. This is what would be considered an “ideal induction” if it were medically necessary.

induction fails

photo credit: Fans of Henci Goer Facebook Page

I love how Henci Goer put it, one of my all time favorite birth authors: “Inducing labor is intrinsically ironic. It works best when least needed and often fails when needed most. It also causes the very problems it was intended to prevent.”

We also see that the babies who are being induced for legitimate, medical concerns may not fare as well because of the circumstances that existed before the induction, but induction can also stand to exacerbate the problems even further. My intention is not to add any more fear or worry into the world, but rather to help dispel the belief that induction is normal, routine, easy and safe. It is none of these, at least not by true definition.

NormalPitocin

photo credit: Fans of Henci Goer Facebook Page

“Normal” in the sense that it is what is appropriate in a healthy state, as opposed to what is common and usual, is not accurate when describing induction of labor. Again I defer to Henci Goer, when she stated in reference to both induction as well as augmentation of labor, “Of course, if 40% of women need oxytocin to progress normally, then something is wrong with the definition of normal.”

So, what ARE some good reasons for induction? Clearly a simple blog post can only capture some of the few that are true, nearly no matter the surrounding circumstances, but in every case it needs to come down to looking over the actual information at the time and weighing carefully everything presented to you. Here are some reasons given for induction:

  • Pre-eclampsia (When it is not able to be controlled with medication and/or diet)
  • You develop or have chronic or acute illness such as high blood pressure, diabetes, kidney disease or other serious infection – that may threaten your health or the health of your baby.
  • The placenta is no longer attached, either partially or completely, to your uterine wall (placental abruption).
  • Your amniotic fluid is too low. (This can be due to something as simple and fixable as dehydration. Also methods for determining this are not clear or uniformly agreed upon by medical professionals.)
  • Your baby has stopped growing (This is hard to accurately determine and is extremely rare.)

due dateNotice that gestational age alone is not enough of a reason for induction, even if you are 42+ weeks. There is not statistically significant enough research to support induction based on due dates alone, likely because they can easily be off by 10-14 days, even with a first trimester ultrasound to confirm dates. If you’re doctor or midwife is practicing evidenced based care, there would need to be additional evidence that the baby needs to come out sooner rather than later.

InduceorNotSo, while there are risks to the mother, the biggest risks to artificial induction are on the baby. This is due to the nature of induction, and the strength of the contractions can be overly strong. Now this can be marginally over what would occur naturally or it can be significant, but when the uterus squeezes the baby that much longer and that much tighter than is natural, brain damage can occur from depravation of oxygen over those short bursts of time. If the induction medication is being used for, say 10 or 15 hours straight, that can really play a toll on the baby. Sometimes it’s not obvious or even determinable… will a few IQ points lower even be noticeable? But other learning disorders like ADD and ADHD have all been linked, directly and clearly, to artificial induction of labor. Other things such as autism, dyslexia, and general learning disabilities are on that radar as well.

pineappleSo for NATURAL INDUCTION methods… basically, they don’t work. Trust me, I’ve tried them. And if they DO, either your body was ready to go into labor on it’s own, or they are powerful enough to also have side effects, like the cohosh herbs and drinking caster oil. Anything else from sex to walking to eating pineapple to spicy food will only get things started IF the body is primed and ready to go into labor. But that sounds like another post entirely 😉

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