Labour Induction

When you’re feeling huge and rolling over in bed requires the help of your husband, booking an induction like a hair appointment can seem like a fabulous idea. But there’s a lot to consider before you decide to go that route, especially the fact that experts agree on the large role failed inductions are playing in the ever-increasing Caesarean section rate.

A 2005 study by the American College of Obstetricians and Gynaecologists (ACOG) determined that inducing first-time mothers was directly associated with an increased risk for C-section. The rate was 12 percent for spontaneous labour, 23.4 percent for medically indicated inductions and 23.8 percent for elective inductions.

Other complications can stem from the fact that due dates are notoriously inaccurate. The same is true for predicting a baby’s size: inducing for a suspected large baby actually increases C-section risk. What’s more, a foetus’s lungs are among the last organs to develop; scheduling an induction before 39 weeks may result in the delivery of a newborn who needs to spend time in the neonatal intensive care unit (NICU).

So who should be induced?
Sometimes, inducing labour is the safest thing to do. If a baby is showing signs of poor growth or distress, or is more than a week or two overdue, he may be healthier if delivered quickly. For mothers with high blood pressure, pre-eclampsia, uncontrolled diabetes or certain other health conditions, a medically indicated induction may mean the difference between a healthy delivery and a catastrophe.

“Inductions are getting a bad rap because we’re doing too many for no reason, but many times they’re an appropriate medical tool,” says Dr Kim Gregory. Elective inductions, on the other hand, are scheduled for convenience – to eliminate messy schedules, middle-of-the-night deliveries and late-pregnancy discomforts. Many experts speculate that up to 50 percent of inductions are elective.

Your body must be ready
Delivering a healthy newborn vaginally depends on having a cervix – as well as a baby – that’s ready. The cervix is assessed by a Bishop Score – a point system of 0 to 3 on five factors, including how far open and thinned out it is. The higher the score, the greater the chance of a vaginal delivery, while totals under five are the biggest risk factor for a C-section. Inductions also can cause medical complications for the mom and baby as well as interfere with the natural labour process.

Pitocin (a drug that stimulates contractions) requires almost continuous fetal monitoring, which decreases a mother’s mobility. Evidence suggests moving around can speed labour. If labour progresses slowly, her amniotic sac may be ruptured to accelerate the process, increasing the risk of maternal and foetal infection. Women who experience powerful, painful contractions caused by Pitocin often request an epidural, which, in turn, may affect blood pressure and circulation to the placenta.

Weigh risks vs rewards
Although many doctors schedule inductions at 38 weeks, the increase in failed inductions, maternal and newborn infections that result from the membranes being ruptured prematurely, C-sections, and NICU admissions have all led to stricter guidelines. In the US, the ACOG states that elective inductions shouldn’t happen before 39 weeks unless the baby’s lung maturity is determined by amniocentesis. Regardless, elective inductions often happen earlier. Making the decision to induce requires thoughtful consideration. Sometimes, it’s just not worth taking a shortcut. “If there’s a medical indication, that’s a no-brainer,” says midwife Karen Parker-Linn.

“The benefit outweighs the risk. But if a woman’s not ready, I won’t induce. I’ll ask, ‘If your baby’s in the NICU and they’re poking him with yet another IV, was your discomfort more important than preventing that?'”

Did you know?
Inducing labour if the pregnancy goes 42 weeks or longer, rather than waiting for labour to start, is safer for mom and baby and reduces the C-section risk.

Want a shorter labour and a healthier baby?
Let nature run its course. Babies delivered before 39 weeks have more complications. So in 2001, US-based Intermountain Healthcare, whose 21 hospitals handle 30,000 births a year, began to eliminate elective inductions for first-time mothers before 39 weeks.

They found that those with a low (0 to 2) Bishop Score (a measure of how “ripe” the cervix is), even at 39 weeks, had labours that averaged 21 hours and C-section rates of almost 50 percent. With a score of 10, labour lasted 91?2 hours and C-sections dropped to eight percent. The result: inappropriate elective inductions declined by more than 50 percent.