Labor and delivery

Understanding induction

By Jennifer Vanderlaan

As you near the end of your pregnancy, you may be considering an induction of labor. Induction refers to the artificial initiation of labor, regardless of the technique. The decision to induce may not be a simple one, since it requires several assumptions.

First, you assume your baby is sufficiently mature to be born safely. The due date is only an estimate and cannot predict when your baby will be ready to be born. Babies continue to develop and mature into late pregnancy. Increasing fat stores will help your newborn regulate temperature. Placental changes allow your immunities to pass through to your baby. Your baby is storing iron and his lungs are finishing the maturation process. Your baby continues to prepare for life right up to the minute he is born.

You also assume your body is ready to go into labor. The hormonal changes of late pregnancy prepare your cervix to stretch, your uterus to contract, and your pelvis to widen. If your body is not ready, attempts to induce labor will be long and slow, if they are successful at all. Knowing your Bishop's score can help you determine how likely induction is to be successful for you.

Another assumption you make is that your baby's health will be better if he is born. Whether this is true in your case may be difficult to determine since the safety of continuing pregnancy depends on the reasons for induction. Many of the common reasons for induction are not agreed upon standards based on research. In fact, very little research has been done to determine when induction is appropriate. Instead, most induction research focuses on finding out which methods are most efficient.

One common reason for induction is a "large baby". The concern with a large baby is based on the fear a large baby is more likely to get stuck while being born. However, modern assessments still do a poor job of predicting which babies will have problems. Another common reason is a baby who is no longer thriving. However, once again, despite modern technology, we are still unable to predict which babies will have problems. Instead of reducing the risks to your baby, the predictions are either ineffective or potentially harmful when a normal healthy pregnancy ends in an induction or cesarean.

You also assume the process of induction is safer than continuing pregnancy. No induction method is risk free. An induction can cause contractions that are too strong for your baby, putting him in danger. Induction requires the continuous use of electronic fetal monitoring, a technology whose use increases the rate of cesarean surgery without any improvement in the health of mothers or babies. Some methods of induction, such as artificially breaking the bag of waters or using misoprostal, cannot be reversed. This means if your baby is in trouble or if the induction does not work, your only option may be to have an immediate cesarean. For about one woman in four, attempts to start labor will fail.

Women who are induced request pain medication more frequently than women not being induced, leaving many experts to believe induced labors affect women differently than natural labors. Artificial oxytocin, a hormone that causes contractions, is a common induction tool. However, because an IV drip of oxytocin does not release the hormone in the same pattern as the body, abnormally large quantities of the artificial hormone are needed to produce sufficient contractions. This difference may explain the higher levels of pain.

Michel Odent, an obstetrician and researcher, believes artificial hormones for labor put the new mother at a disadvantage. Oxytocin is a love hormone. Released during orgasm, labor, and while breastfeeding, oxytocin is one of the hormones responsible for bonding. Once it is released into the bloodstream, it is not able to cross the blood-brain barrier. Women whose labors use artificial oxytocin do not benefit from the emotional bonding aspects of the oxytocin because it never has a chance to reach their brain. This may put them at a disadvantage in the first few days with their newborn.

Choosing to initiate labor before your body is ready is one of the most dramatic ways to interfere with pregnancy. Trying to determine if induction is right for you can be a difficult task. If you believe it may be safer for your baby to be born than for pregnancy to continue, getting the answers to the following questions may help you make your decision.

1. Why is induction being suggested?
2. How often does this reason cause problems when induction is not used?
3. What method of induction is being planned?
4. What will be done if the induction does not start labor?
5. Will I be allowed to eat and drink at will?
6. How much time will I spend on a monitor?
7. Will I still have access to comfort tools such as the shower, tub, birth ball, walking, and position changes?