Induction: Knowing your Options
Once upon a time, humans had little control over the date on which a baby would be born. Whether it be a week or two before the due date, or days or weeks after, women waited to be awakened in the middle of the night with intense cramping or for the waters to break suddenly during some daily activity. On occasion, when conditions warranted it, midwives and healers used herbs, physical techniques and traditional therapies to suggest labor. But even the wisest of traditional medicine women of old couldn’t have answered the infamous question: “When will this baby be born??”
Nowadays, modern medicine can provide more control over the timing of a baby’s birth. There are mechanical and pharmaceutical methods to initiate labor and, of course, the surgical option of a C-Section. As a result, induction of labor has become increasingly common. The World Health Organization (WHO) estimates that, “in developed countries, up to 25% of all deliveries at term now involve induction of labor.” Other sources indicate that the rate is even higher. A 2013 survey from Evidence Based Birth claimed that up to 44% of labors are induced.
Is this a good thing? What are the benefits of starting labor before nature does? What are the risks of doing so?
In simple terms, labor inductions are intended to prevent potential problems as babies get bigger, as placentas get older, as amniotic fluid gets less, or any other changes at the end of pregnancy that could create a complication. Yet, interestingly, there is no current compelling evidence that induction actually improves birth outcomes overall. Even more striking, statistics clearly indicate that inductions are more likely to end in C-Sections than labors that begin spontaneously.
The medical system has universal protocols that attempt to serve a wide and diverse population. Yet, when and if we look closely at these routine procedures, we may assess that we, as individuals, would benefit from and prefer individualized plans. In addition, the dictates of medicine are often based on assessment of risk rather than actual statistics of incidence. Thus, many of the medical protocols assume worst case scenarios and try to prevent them. Yet, those worst case scenarios are extremely rare. So, following from this, we know that there are compelling reasons for induction (like maternal hypertension or unmanaged maternal diabetes) but that most inductions are not necessary for the health of the mother or the baby.
The important point is that pregnant people almost always have the power to make a choice whether to be induced or not. Some families want the option to induce their labor at will (these are called “elective”) and some families want to wait for the natural mechanism of labor to begin. In order to make such a choice, it is essential that each family understand the benefits and the risks, find different sources to create a balanced viewpoint, and then make a decision based on the evidence, their gut feeling, and their value systems or beliefs.
It’s not easy, of course, to go against medical advice or protocol or even to question it. In her book
Inducing Labor: Making Informed Decisions, midwife and researcher Dr. Sara Wickham offers straightforward questions to use if your provider suggests labor induction. This can be a helpful tool to give you the confidence to clarify your particular situation.
Why do you feel I need to be induced?
Am I or my baby in imminent danger?
What are the specific benefits of induction in my case?
What are the risks of being induced?
What percentage of women who are induced in this hospital end up having a C-Section or instrumental birth (forceps or vacuum extraction)?
What choices do I have if I have my labor induced?
What are the alternatives to having labor induced?
What if I wait and think about it for a couple of days?
As a homebirth midwife, I believe in the natural process of labor and birth and prefer not to intervene or try to control it unless I perceive an imminent threat to the mother or child. If you feel the same way about your pregnancy, be confident, look at the evidence, and find people and resources to empower you to make independent choices for you and your baby. Here in Springfield, there are naturally minded birth workers, doulas, homebirth midwives who would be willing to support you as you navigate this process.