Why Induce Labor?

Is It Worth the Risk?


A friend is due this week with her first baby. She’s healthy, hasn’t gained too much weight, and in her own words, “has had a perfect pregnancy.” We chatted about how hard it is to wait for labor she said, “I’m fine with waiting but my doctor won’t let me go past my due date. He wants to schedule an induction.”
I asked if that was what she wanted and she replied, ”Well, I don’t know. If that’s what he thinks is best. I guess.” I asked why he wanted to induce and she said, “I don’t really know. He said it would be easier not to wait.”
I asked if she had any health problems? “No.” Was the doctor worried the baby was too big? “No,” she said, “He just said it was better.”
“Is this the kind of birth you envisioned?” I asked “No,” she replied. “I thought I’d go into labor naturally.” She confided she worried she’d end up with a C-section she didn’t want. “Then why,” I asked, “are you considering an induction?” “Because, I didn’t know I had a choice. I figured if my doctor said so, I had to get one. I didn’t know how to say ‘No’.”
This conversation bothers me on so many levels.
1) This woman is healthy, not overdue and has different ideas about the labor she wants.
2) She thinks she has to go along with her doctor, even though she doesn’t particularly want or understand why he recommends induction.
3) Her doctor apparently didn’t explain why induction was “better” or “easier.” If he had a specific reason, his patient was unaware of it.
4) In this day and age when the C-section rate is already so high that the World Health Organization is worried, why are we still inducing healthy, first-time mothers who aren’t high-risk?
Inductions are easier than spontaneous labors for some doctors because they give them an element of control. They know, more or less, when they’ll need to hang around the hospital. It’s tough to run out in the middle of the night or office hours for a delivery. Sometimes, induction is essential for mother’s or baby’s health. Far too often, however, they’re a matter of convenience and routine.
Not everyone’s worried about the C-section rate. Many doctors and patients are fine with it. Their reasons range from convenience and liability factors to some very valid medical concerns. The majority of women, the American College of Obstetricians and Gynecologists, and the World Health Organization, however, aren’t so keen on it.
The WHO’s goal was to drop every country’s C-section rate to 10-15% by 2010 because studies show higher rates increase maternal mortality. Currently, the US rate is almost 32%. While many of those are scheduled, repeat C-sections due to reluctance to participate in vaginal birth after cesarean, many are due to failed inductions. Studies confirm inductions in first time mothers double the risk of having a C-section.
Why? When and why a woman goes into labor is a complicated dance between mother and baby’s anatomy and physiology. When both are ready for delivery on their own, labor tends to go more smoothly than when we try to make them ready by inducing labor. There’s a whole lot that goes on behind the scenes in that uterus that we can’t manipulate with medications and technology. Mother Nature’s a smart chick and except for cases of real medical necessity, she’s got the better birth plan.
If we’re serious about ever achieving the goals the greater medical community agrees are healthiest for women and children, we have to quit doing inductions for convenience. How do we do it? Just say, “No thanks.” Tell your doctor you prefer to wait for labor to start spontaneously.
If there are significant medical concerns, get your doctor to explain them. Sometimes an induction is essential. If it’s simply a matter of convenience, think again. Your doctor is your employee, not your boss. You don’t have to blindly do as he/she says. Seriously, our health is at stake.
Got a question for Jeanne? E-mail it to labornurse@fitpregnancy.com and it may be answered in a future blog post.
This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.