Elective Inductions

02.17.11 When making an exception is the best choice.


There’s an article in the news this week that absolutely breaks my heart. A woman in Texas was induced at 38 weeks so her husband could meet his baby before he died. It was their fifth child and he had cancer. After a successful vaginal birth, the dying man was able to hold his daughter a couple of times. A few days after she was born, he slipped into a coma and died.

If that doesn’t make you hug your family a little closer and count your blessings, I don’t know what would. The other thing about this story that makes me sad are the comments left online by some extremely opinionated and poor-mannered readers. While most agreed they’d do the same thing – get induced so baby and dad could meet before they said goodbye forever – others had harsh, judgmental things to say about induction, her decision to deliver early and more. I have to wonder, what kind of world do these people live in that their hostile opinions are so important, even when it comes to a baby, a dying man and his wife’s last gift. Geez, people, have a heart or at least a little common courtesy.

I’m pretty conservative about recommending inductions. I think Mother Nature’s day planner is usually better at picking birthdates than Mom, her midwife or doctor. I think inductions should be reserved for medical reasons and extreme situations. I don’t think elective inductions for no good reason other than convenience and aches and pains are a good idea, because they’re associated with too many complications. But this women’s situation was extreme and I’m so grateful induction was a possibility for her.

Here’s why it was an excellent choice: This woman had delivered several babies before so her body knew what to do. If it were her first baby, a 38-week induction might be risky since she’d never have dilated and had a baby vaginally. There’s a good chance a first-timer delivering two weeks early will wind up with a c-section and under the circumstances this woman was facing, that could have been a nightmare.

Instead, this was an experienced mom who was apparently already showing signs of labor. Her baby was pretty close to done in the oven. At 38 weeks, she was close enough to her due date that she felt safe taking a calculated risk. She followed her heart and went for it. And I’d have done exactly the same thing. For the rest of their lives she’ll hold the memory that her husband and her baby girl knew each other, if only for a moment.

The pendulum has swung hard from the days when inductions were as popular as cupcakes and everyone could sign up for an early delivery. We were too casual about it and wound up with record rates for premature deliveries and c-sections. We’ve learned from those mistakes and now recommend a far more thoughtful approach when considering inductions. Does that mean an elective induction is never a good idea? No. Some non-medical circumstances call for it and it’s a blessing we have that option available.

I had an elective induction with my last baby when was almost 40 weeks pregnant. I had a 4-year-old, 10-year-old, 12-year-old, 16-year-old and an 85-year-old (my very fragile father who lived with us). No other family members lived near by and no one other than my husband, nanny and myself could manage our clan’s unique needs (including those of an ancient, incontinent old man with a long list of medical problems). The idea of starting labor in the middle of the night and having no one to call to supervise the kids and my dad was not only anxiety-provoking, it would have been irresponsible.

We talked it over with my doctor and agreed that an induction was the sensible thing to do. We arranged for our nanny to stay with the at-home team and my baby was born vaginally. And it’s a good thing I’d had the foresight to put my nanny in charge. My dad was so excited about meeting the baby he threatened to find his keys (which had been taken away years before after one-too-many fender benders) and drive the little ones to the hospital to meet her. With my nanny on duty, I was able to relax (well, as much as a woman in labor can relax) and do what I had to do.

Making any kind of medical decision is all about risks versus benefits, common sense and a bit of luck. Think twice about scheduling an induction non-medical reasons, but if you’re in an extreme situation, it might be the wisest decision you’ll make.

Jeanne Faulkner, R.N., lives in Portland, Oregon with her husband and five children. Got a question for Jeanne? E-mail it to labornurse@fitpregnancy.com and it may be answered in a future blog post."¨"¨

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