Inducing labor has become so widespread and uncontroversial that when Abby Epstein called some New York obstetricians during the research for our 2008 ﬁlm, The Business of Being Born, their voicemail had, among its choices, “If you’re calling to schedule your induction, please press two.”
There are valid medical reasons for induction, and these apply to about 10 percent of pregnancies (see “7 Good Reasons to Induce”). But doctors [in the U.S.] induce about 40 percent of women, the most common reason being that the caregiver says they are “overdue.” In fact, many obstetrical practices routinely offer induction after you’ve reached 38 weeks. While the assumption is that pregnancy lasts 40 weeks, recent studies of healthy women show that ﬁrst-time mothers typically go a week or more past that. In fact, in France doctors say pregnancy lasts 41 weeks and plot due dates accordingly.
While establishing a due date is a routine part of your ﬁrst prenatal visit, it’s essentially a guess; yet it becomes a huge determining factor in whether you are a candidate for induction. This initial due date calculation could be as much as a week off. Ultrasounds are not a very good way to establish an accurate due date, either: They can be off by as much as ﬁve days in the ﬁrst trimester and even more at the end of pregnancy.
This may not sound significant, but many studies have found that when labor is induced, the risk of a Cesarean section doubles, especially in a ﬁrst-time mother whose cervix may not dilate as quickly. Surveys have shown that many women are not informed of this risk before electing to induce.
Reasons not to induce
Let’s not dump all over the doctors here. A top priority of many working moms-to-be has become scheduling maternity leave and prearranging care for older siblings during the birth. Also, many women prefer to schedule a “daylight delivery” to ensure that their preferred OB-GYN will be present. Plus, toward the end of pregnancy women are likely to scream from their bedroom windows, “I want this baby out of me!” But neither this nor the following are valid reasons for induction:
• The ultrasound technician suddenly wants to move your due date closer. This means that according to this person, you are already overdue. But in the last month of pregnancy, these estimates are only accurate plus or minus three to four weeks.
• You’re told that your baby is getting too big. Weight estimates can be off by as much as two or three pounds.
• Your doctor is leaving town or has scheduled a vacation. And you want to deliver while your doctor is on call.
• Your amniotic ﬂuid is low. This drop in ﬂuid level can sometimes be countered by bed rest and drinking more water. Also, the quantity is just a rough estimate.