According to a nationwide survey, 41% of women in the USA experience medically-induced labor inductions (1). Today we’re going to explore the 3 most common reasons labor inductions happen, inducing labor pros and cons, and perspective if your goal is a natural childbirth.
Inducing Labor Pros and Cons #1 : Baby was full term/close to due date
(44% of all medical inductions)
From a purely medical perspective, an induction at or close to the due date is NOT considered medically necessary. However, there may be some physical or emotional benefits to labor induction at term. Weight gain, back pain, varicose veins, and sleep problems all increase as pregnancy progresses. Labor induction and birth put an end to the discomforts of pregnancy. In fact, 19% of women ask for inductions because they would like to be done with their pregnancy (1).
Additionally, most moms are beyond eager to finally meet their baby! Labor induction allows them to do so when their doctor of choice is on call and on a date that is most convenient for them.
Another scenario where labor induction may be considered is if mom had a precipitous (very fast) birth with her last baby. If you live far from the hospital and give birth quickly, a labor induction may be considered as an option so that you don’t give birth en route to the hospital.
One main risk of a labor induction at term or close to the due date is premature birth. Your due date might be inaccurate, and a medically starting labor could mean that your baby will be born too early.
Prematurity can bring significant risks to your baby. Premature babies are more likely to have vision and hearing problems, challenges sucking and swallowing, and a low birth weight. Important organs like the baby’s brain, lungs, and liver do a lot of developing in those last weeks of pregnancy; development that can be cut short by an induction (2).
Assuming you’re having a safe and healthy pregnancy, it’s often safest for baby not to consider a labor induction until you’re is closer to 41 or 42 weeks pregnant.
Inducing Labor Pros and Cons #2: Maternal health problems
(18% of all medical inductions)
There is a shortlist of scenarios and health challenges in which an induction can promote the safest outcome for mom and baby. These include conditions such as:
- Pregnancy Induced Hypertension
- Placenta previa or placenta accreta
- Fetal grown restriction
- Poorly controlled gestational diabetes
- (Maybe) twin or multiple pregnancy
Let’s take a closer look at one medical condition — Pregnancy Induced Hypertension, also known as Toxemia. This is a condition where mom has elevated blood pressure, among other symptoms. When it is severe, the hypertension can prevent adequate blood flow to baby through the placenta and umbilical cord (3). Toxemia resolves once the baby is born. When medications and bed rest don’t help the condition, an induction may be the safest option for mom and baby.
Labor inductions alone introduce their own serious health risks to mom and baby. For example, inductions can cause hyperstimulation of the uterus, where it contracts too often and decreases blood flow to the baby. Labor induction also increases a woman’s risk of serious bleeding after the delivery. Additionally, a first-time mom who has a labor induction at term is more likely to experience a cesarean delivery, which is a major surgery with its own accompanying risks (4,1). Finally, labor inductions are associated with a greater use of pain medication in labor, and introduce a cascade of interventions that accompany epidurals and narcotics.
Inducing Labor Pros and Cons #3: Care provider was concerned about the baby being too big
(16% of all medical inductions)
The average birth weight for babies in the US is 7lbs 5oz. A baby being “too big” is technically called macrosomia, and is defined as a birth weight above 8lbs 13 oz. This determination is often made prenatally during a late ultrasound or through fetal measurements.
- Risks of delivering a large baby include:
- A longer-than-average labor
- Higher rates of c-section birth
- Shoulder dystocia
- Fourth-degree perineal tears
- Maternal postpartum hemorrhage (5)
When a woman has uncontrolled or poorly managed gestational diabetes, her chances of delivering a large baby are greater than women who do not have gestational diabetes (6). Please note the use of “uncontrolled or poorly managed” diabetes, because this is not true of all cases where mom is diagnosed with gestational diabetes. In some instances, an induction might be a good idea to help curb the rapid weight gain that occurs in the last weeks of pregnancy.
Ultrasounds performed late in labor to determine baby’s size are often inaccurate (7). In a recent survey, 32% of women were told during pregnancy that their baby might be getting too large. Of these women, the actual average birth weight of their babies ended up being only 7lbs 13oz (1). This is well below the size limits of macrosomia.
For a healthy woman with a low-risk pregnancy, there is a strong likelihood that her baby is an average size, despite late ultrasound measurements. Thus, inducing labor for concerns about the baby’s size may result in unnecessary intervention and risk.
INDUCING LABOR & NATURAL CHILDBIRTH
I’m often asked if a labor induction makes it harder to have a natural childbirth than a spontaneous labor (one that starts on its own). For many women, yes, they feel that it does makes a natural childbirth more difficult. But if a labor induction is medically necessary and can’t be avoided, rest assured that you can still have a natural childbirth. You can read all about my personal experience in Induction Without Epidural: My Natural Birth With Baby #2.
But if an induction is NOT medically necessary and you have options, it’s usually wise to avoid a labor induction. Here’s a short-list of the reasons why:
Labor induction with pitocin creates synthetic contractions that do not have the same ebb and flow as your body’s natural, oxytocin-induced contractions. They may last longer, come closer, or be more intense than a spontaneous labor. This can make it more likely for a woman to seek pain medication.
A labor induction typically requires that you have an IV infusion of pitocin and other fluids. This means that you’ll be connected to an IV pole throughout your labor. An induction can limit your mobility, making it more difficult to move and changes positions during your contractions. The IV may also prevent you from getting in the tub and using hydrotherapy, which many women find helpful during a natural birth.
On the Clock
Your doctor will likely want your baby to be born within a set period of time after starting the labor induction. If the induction is started before contractions begin, there’s a chance that pitocin won’t stimulate effective contractions (ones that cause effacement and dilation of the cervix). Or, if your body isn’t ready to go into labor and it takes longer than expected, you may be encouraged to have a cesarean birth. With a spontaneous labor, you can usually labor at home until active labor when your contractions are in full swing (this depends on your medical conditions, of course), which makes it much less likely for a cesarean birth to occur.
Ultimately, inducing labor pros and cons really depend on the reason that an induction is being suggested. Once you clearly understand the reason, then take a close look at the research. The KOPA® PREPARED online childbirth course series will provide a thorough discussion about labor induction, and will point you in the direction of research studies to read.
Do your best to see if an induction is likely to lead to a safe outcome for your circumstances. This preparation will enable you to make the best choice for you and baby, and will help set you on the path of a positive birth experience.
Kopa Birth’s online birthing classes allow you to prepare for a natural hospital birth from the comfort of your own home, 24/7. Enroll today in our free online childbirth class and start preparing for your natural birth!
(1) Declercq ER, Sakala C, Corry MP, Applebaum S, Herrlich A. Listening to MothersSM III: Pregnancy and Birth. New York: Childbirth Connection, May 2013.
(2) March of Dimes. (2012, January). Inducing Labor. Retrieved from http://www.marchofdimes.org/pregnancy/inducing-labor.aspx.
(3) Childbirth Connection. (2014). Best Evidence: Induction of Labor. New York: Childbirth Connection.
(4) National Collaborating Centre for Women’s and Children’s Health (UK). (2008). Induction of Labour: Complications of induction of labour. London: RCOG Press; (NICE Clinical Guidelines, No 70.) 8.
(5) Stotland, N.E., Caughey, A.B., Breed, E.M., Escobar, G.J. (2004). “Risk factors and obstetric complications associated with macrosomia.” International Journal of Gynecology and Obstetrics. 87: p 220-226.
(6) Alwan, N., Tuffnel, D.J. (2009). “Treatments for gestational diabetes.” Cochran database of systematic reviews (3): CD003395.
(7) American College of Obstetricians and Gynecologists. (2014). “Committee opinion no 611: Method for estimating due date.” 124(4): 863-6.