Inductions

From time to time, women will ask about induction of labor for many different reasons. Unfortunately, the response is often a no on our part. While we are often empathetic when it comes to the miseries of pregnancy, the reality is that inductions are not a benign procedure. Inductions often involve greater risks than spontaneous labors and are far more time-consuming than most women realize.

It seems to be a common misperception that if a woman is scheduled for induction, she'll have her baby that day. It ain't necessairly so! Women who have a 'favorable' cervix are likely to have a baby in one day but not always. A favorable cervix is one that is thin (effacement), preferably already dilated a little, and midposition or anterior (where the cervix is - if I ask you to put your balled up fists under your hips - that's not a good sign!). An unfavorable cervix would be what we call 'closed, thick, and high. Oftentimes, when the cervix is unfavorable, an induction can take 2, even 3 days. Sometimes women might be sent home to return in a few days to try again. Spending 2-3 days in the hospital just trying to have the baby gets old quick! The beds aren't comfortable, you have people going in and out of your room at all hours of the day and night, no food on demand, etc.

Another common misperception is that inductions are not harmful. There are risks involved in any 'procedure'. Women who are induced, particularly with unfavorable cervices, are more likely to end up with a cesearean section, especially if it's their first baby. The risks of induction can vary depending on what type of induction is being done but the big ones are fetal distress (where the baby does not tolerate the labor) and emergency c/s.

Women may be offered induction when there is a medical reason to do so. These reasons might include gestational diabetes, blood pressure issues, and post dates (and in our practice this isn't considered typically until 41 weeks and some women choose to go until 42 weeks). Having a big baby is NOT a reason to induce - research has shown that women with big babies are more likely to be sectioned when induced then if they had awaited spontaneous labor.

Elective inductions (induction for social reasons) are occasionally done with a favorable cervix. However, not prior to 39 weeks since the latest research now shows that baby's brain development may continue up until this point. Elective inductions are typically done when a woman's cervix is very favorable...for example the exam is 3-4cms, 70-100% thinned out, and the head is down low (-1 or better) in the pelvis.

Women who are planning natural childbirth would benefit from avoiding induction. The methods of induction, while they may vary, can be more limiting on a woman who plans natural childbirth. For example, having to be on the fetal monitor continuously while using pitocin or cytotec. A spontaneous labor is much more tolerable than a forced one. While pitocin attempts to mimic a woman's own natural hormone (oxytocin), it's impossible to administer it in the same pulsatile fashion that a woman's brain will do. This often creates a more intense labor, thereby making it more difficult to labor naturally (without pain meds).

Here's what an induction can look like at it's worst...

Day one 6am - Admitted to the hospital. Pitocin started. That evening, no cervical change has occurred so pitocin stopped and woman to rest through the night.

Day two 5am - pitocin restarted. Late morning some change in cervical exam. Water broken. Continue pitocin. That evening, no change in exam. Pitocin stopped and cytotec started through the night.

Day three 7am - cervical exam much more favorable with good change, pitocin restarted. Delivery 5 hours later.

Now, not all inductions are this lengthy, but it's hard to predict in advance how an induction will go.

Being induced is not a decision to take lightly!