Like most pregnant women, you’ll probably reach a certain point during pregnancy when you’ve had enough.
Enough of being pregnant, uncomfortable, sore and tired. Enough of waiting to meet the tiny person you’ve been growing for the last nine months.
Even though you don’t really like the idea of having an induction, getting the ‘heavily pregnant’ part over and done with sounds very tempting.
Some women genuinely need to have their labour induced. There are certain situations — for example, pre-eclampsia — where continuing the pregnancy is more of a risk to mother or baby than having an induction.
What Is An Induction Of Labour?
When labour begins on its own (spontaneously), it triggers an amazing and complex process, involving your baby, your body and your brain.
Your baby signals when he or she is ready for life outside the uterus and your brain responds to this signal by releasing oxytocin. During labour, this powerful hormone causes your uterus to contract, dilating the cervix and pushing your baby out. As levels of oxytocin rise, your brain releases endorphins – nature’s painkillers.
Induction of labour bypasses these two critical steps in the labour process. Your baby has not given the ‘ready to be born’ signals and so your body can’t respond to those signals with its own hormones.
The last weeks of pregnancy are very important.
During this time, your antibodies are passed to your baby, so the baby is prepared for fighting infection and disease after birth. The baby is also gaining essential fat and iron stores, as well as honing skills like sucking and swallowing.
Brain development also accelerates in the last 5 weeks of pregnancy. Most importantly, your baby’s lungs are still developing, and researchers now believe there is a connection between lung development and labour.
In the weeks before labour begins, estrogen levels rise and progesterone levels drop, increasing the uterus’ sensitivity to oxytocin and preparing it for the work to come.
Braxton Hicks or ‘pre-labour’ might start the process of thinning and opening the cervix, as well as encouraging your baby to get into the optimal position for birth.
This entire process ensures labour is effective and your baby is completely ready to be born – able to adjust to life outside the uterus and start a successful breastfeeding relationship with you.
Induction essentially replaces the natural process that happens over weeks, and forces your body to go through it in a few hours. Your cervix is artificially softened and your bloodstream is flooded with synthetic hormones. Contractions are forced to happen quickly and the tempo of labour increases over a short space of time. This makes the pain much harder to manage.
Induction means you are constantly monitored. You will also have an IV drip in place, which restricts movement and your ability to work with the contractions. Induced contractions become much stronger more quickly and are harder to cope with, so there is a greater chance that you will need to request an epidural.
You will be checked regularly for fetal distress, as a baby’s heart rate tends to dip in response to the stronger contractions.
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Why Is Labour Induced?
The big question is this: Why would a low risk woman agree to be induced if her baby was not in danger?
An induction only introduces real risks to what could be a perfectly normal birth. These are the most common reasons for induction:
#1 Post Dates
Full term is estimated to be between 37 and 42 weeks of pregnancy. Your estimated due date (EDD) falls around the 40 week mark, calculated as 288 days from your last menstrual period.
Many hospitals have a policy of induction at 10 days after the EDD. In the US over 44% of women report being induced because they were full term (over 37 weeks) and were near their EDD.
Given that women have individual differences and various factors in their lives that influence their menstrual cycles, it is unreasonable to think babies should be evicted forcefully if they don’t arrive at the ‘right’ time. Research shows that pregnancies can vary in length naturally by 5 weeks.
You can read more in Estimated Due Dates And The Myth Of The 40 Week Pregnancy.
#2 Premature Rupture Of Membranes
When the amniotic sac ruptures before labour begins (waters break), it is called premature rupture of membranes (PROM). Many women are given a time frame for contractions to begin naturally (usually 24 hours), and after that they are induced, to avoid the risk of infection.
The results of this study showed women who had experienced PROM and were screened for Group B Strep had very good outcomes when they waited for labour to begin. Induction of labour lowers the risk of infection in the mother, but not in the newborn baby; neither does it reduce the risk of needing a c-section
Antibiotics are commonly used as a preventative measure, for women whose waters have broken and labour has not begun. This review of four studies showed giving routine antibiotics (where PROM occurred at full term) did not reduce the risk of infection in pregnant women or their babies.
You can read more in What Is The Real Risk Of Infection After Waters Break?.
#3 Suspected Large Baby
The medical term for a big baby is macrosomia. Most guidelines consider babies to be big if they weigh over 4500 grams (4.5kgs), or 9lbs 15oz.
There are many reasons why some babies are larger than others – reasons related to genetics or to underlying health issues, such as gestational diabetes. There’s no way to measure a baby’s size and weight accurately before birth, so babies are only ‘suspected’ to be large until they are born.
Ultrasounds are not 100% accurate and there are many reports of women being induced because of a ‘big baby’ when their babies’ birth weight turns out to be average or lower.
The main concern with birthing a big baby is the risk of shoulder dystocia, where the baby’s shoulders become stuck. Often care providers will recommend induction at 38 weeks to avoid this risk.
Induction carries risks and there is no evidence to show induction for a suspected big baby improves outcomes; in fact it increases the risk of c-section.
You can read more in Macrosomia – 5 Myths About Big Babies And Birth.
#4 Intrauterine Growth Restriction (IUGR) At Term
The growth of your baby during pregnancy depends on several factors: genes, your health, and how well the placenta is functioning.
Some babies are small for their gestational age and others are growth-restricted because they are not receiving enough nourishment via the placenta.
As in the case of a suspected big baby, it is only possible to tell whether a baby is small genetically or because of a medical problem when the baby has been born. A diagnosis of IUGR relies on accurate dating in early pregnancy.
A study from the Netherlands shows waiting for labour to begin spontaneously has the same outcomes as induction for babies suspected of IUGR. The results show significantly more babies in the induction group were admitted to high or medium-level NICU care. The babies in the expectant management group, who were born when they were ready, were about 100 grams heavier than the babies in the induction group.
#5 Oligohydramnios
During pregnancy, your baby is surrounded by a sac filled with liquid called amniotic fluid. It protects your baby and the umbilical cord from trauma and infection.
Amniotic fluid is produced by the mother, absorbed by the baby through swallowing, and then excreted via the baby’s lung secretions and urine output. After 2o weeks of pregnancy, fetal urine is the primary source of fluid. The levels fluctuate, depending on how hydrated the mother is, how much the baby swallows and urinates, and whether the baby has problems with kidney function.
About 4% of women are diagnosed with low amniotic fund levels, or oligohydramnios. Low risk women at term (37-42 weeks) with a suspected diagnosis of oligohydramnios can either wait for labour (with monitoring) or be induced.
The vast majority of doctors will push for induction over expectant management. This is despite the evidence showing labour induction does not improve outcomes for babies but increases the risk of interventions and c-section. You can read more about this in Low Amniotic Fluid Levels – Oligohydramnios.
How Is Labour Induced?
Every woman’s situation is unique to her own health and the wellbeing of her baby. In order to decide between induction and waiting for labour to begin spontaneously, women need to be provided with the benefits and risks of both options.
Before choosing to be induced, you need to be aware that in most cases you can’t change your mind after the process has begun, especially in the case of artificial rupture of membranes. In the majority of situations, after an induction has begun, you will need to do whatever is needed for your baby to be born. Unless there is a clear risk in continuing with your pregnancy, induction should be an absolute last resort.
The 5 main methods of induction of labour are:
- Stretch and sweep of membranes
- Artificial rupture of membranes
- Synthetic oxytocin drip
- Prostaglandin gels
- Balloon catheter
You can read more about stretch and sweeps here and the other methods of induction here.
This information not intended to frighten you, but to help you make a balanced, informed decision based on the risks and benefits. When it’s a question of life-saving benefits, of course, there is no risk you wouldn’t take. But if your or your baby’s life is not in danger, it’s worth considering whether induction is worth the risks to you and your baby.
Induction of Labour – What Are The Risks?
So if there’s a genuine medical reason why your baby should be born as soon as possible, this article is not for you. However, labour inductions happen more commonly for convenience rather than for medical reasons.
Sometimes it’s simply because a date has passed or a woman’s preferred doctor isn’t available around the due date. Having an induction of labour isn’t a simple procedure and it’s not without risk. It’s not about having a bit of medicine and your labour will work just like it would have naturally.
To decide whether or not to have an induction, you need to ask yourself whether being induced is more likely to help or harm you and your baby.
“Inducing labour involves making your body/baby do something it’s not yet ready to do. Before agreeing to be induced, be prepared for the entire package, i.e. all the steps. You may be lucky enough to skip one step, but once you start the induction process, you are committed to doing whatever it takes to get the baby out, because by agreeing to induce, you are saying that you or your baby are in danger if the pregnancy continues. An induced labour is not a physiological labour, and you and your baby will be treated as high risk — because you are.” — Doctor Rachel Reed
Get Informed About Induction
An induction of labour triggers what is known as ‘the cascade of interventions’. What does that mean? The clip below is a snippet from the documentary, The Business of Being Born — essential viewing for anyone having a baby. If you don’t have time to purchase the DVD, you can watch the documentary via live streaming.
Finally, watch this clip from the late Marsden Wagner. Marsden was a Director of Maternal and Child Health for the World Health Organization.
