Read an excerpt from a new book by Ricki Lake and Abby Epstein
Inducing labor has become so widespread and uncontroversial that when Abby Epstein called some New York obstetricians during the research for our 2008 ï¬lm, 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. 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 ï¬rst-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 ï¬rst 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 ï¬ve days in the ï¬rst 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 ï¬rst-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 ï¬‚uid is low. This drop in ï¬‚uid level can sometimes be countered by bed rest and drinking more water. Also, the quantity is just a rough estimate.
Labor is a complicated process and it's not so easy to get it started in a way that won't potentially cause some harm to you or the baby. These days, the most common method of induction is the use of the drug Pitocin. The blockbuster contractions it causes send the baby forcefully forward and decrease blood flow from the placenta; this can lead to fetal distress. Symptoms such as spikes in the baby's heart rate and the presence of meconium (the baby's ï¬rst bowel movement) in the amniotic ï¬‚uid often get doctors to recommend a C-section.
The next most common method of induction is breaking the bag of waters. Once this happens, most doctors give you only 24 hours to deliver before recommending a C-section, even if your baby is not in distress; that's because there's an increased risk of infection.
When your baby's not ready
Some research indicates that when the baby's lungs are mature, she releases a hormonal signal that begins contractions. So if birth commences artiï¬cially, is she fully ready to greet the world?
The quick progress of some induced labors can mean that not all aspects of the process are ready for the baby to arrive. If the cervix is completely dilated and the baby has descended low enough but has trouble maneuvering the last little bit, the doctor may need to use a vacuum or forceps to pull the baby out. This presents some risk to the baby's head and pretty much guarantees you are going to have a vaginal tear or an episiotomy.
For all these reasons, think carefully before you agree to being induced or having your labor augmented by Pitocin. Don't let anyone rush you into this decision. Inductions are scheduled in advance, like some C-sections, which should allow you time to talk with your caregivers and your partner and weigh the beneï¬ts and risks carefully before agreeing.
From the book Your Best Birth: Know All Your Options, Discover the Natural Choices, and Take Back the Birth Experience by Ricki Lake and Abby Epstein. Copyright (c) 2009 by Azzura Productions, Inc. and Barranca Productions. Reprinted by permission of Wellness Central, an imprint of Grand Central Publishing. All rights reserved.
To see a trailer or to download a copy of The Business of Being Born, go to www.thebusinessofbeingborn.com.