Induction: Why So Many Inductions?

Several of my friends have had babies and ALL have been induced. This seems very peculiar to me. If birth is a natural process why do women's bodies not work as intended? Or is this just unnecessary medical intervention?

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

This is such an interesting issue. It certainly may appear that the female body can not be relied upon to safely birth babies in a timely and predictable fashion. I, however, feel rather it is the medical profession, consumer demands and concerns about litigation which have served to increase the rate of induction of labor from 9 percent in 1989 to 18 percent by 1997.

The last weeks of pregnancy are often associated with significant discomforts; swelling, pressure, shortness of breath, urinary frequency, incontinence, back pain and more. Physicians may have trouble saying "no" to women who want to be induced -- who literally beg to be induced. Care providers also are fearful of "something happening" if induction is refused or delayed and fear that they will be held liable in that situation.

Most women receive an ultrasound at some point in their pregnancies, which provides a cushion of comfort for the physician. It is unlikey that a preterm baby will accidently be induced. This is a double-edged sword, however, because ultrasound provides couples with a due date -- a date that may or may not be more accurate than a woman's own dates. Women tend to rely on an ultrasound due date and when that date has come and gone (and perhaps the menstrual due date has also) they become anxious and begin to question the judgement of the care provider. Stories of fetal distress, meconium fluid and even stillbirth abound and women fall prey to the "induction lure."

At an initial obstetric visit, I calculate an EDC or EDD (expected date of confinement or delivery) based on the first day of a woman's last period. If this date is firm and she has monthly cycles and the uterine size is consistent with these dates, I provide her with a due date. I then calculate the dates two weeks on either side of that date and tell her that the normal end of gestation is between these dates. When I get an ultrasound EDC on a client, I never change her due date unless there is a very sound rationale and there is very good evidence why we should not rely on her dates.

As a due date approaches, it is important to remind a woman that normal gestation can go to two full weeks beyond her due date. We perform tests which reassure her, and us, of the baby's well being, but do not induce labor unless medically indicated.

Although induction may seem attractive when the discomforts of late pregnancy occur, women need to become informed of the risks of induction. Significant among these is the fact that she will spend her entire labor in the hospital, where infection and intervention are true risks. By necessity, an induced labor must be monitored, initially internally but often progressing to the use of an internal catheter and fetal scalp electrode. In most settings, it is difficult to obtain a good tracing with the mother up and active so she is confined to bed. She is generally not encouraged to leave her room, even if she is allowed to be up in a chair. In most cases, she may not use the tub, shower or positions which interfere with the monitor tracing.

Fathers or labor support people can be "left out" with much attention paid to the monitors and accurate tracings. Induction requires an intravenous line so this also restricts her movements to some degree. Pitocin or oxytocin is started at a precisely prescribed dosage and increased at intervals of 10 to 20 minutes until "active labor" is established. Because Pitocin can hyperstimulate the uterus, the nursing staff is alert for any fetal heart problems or any abnormal uterine contraction pattern.

Although induced labors are not necessarily more painful, many women say that they are more intense; there is very little "warm-up." During an induction, women are often denied food and drink, other than sips or ice chips. Research has shown that more pain medication is accepted by women who are induced than those who have spontaneous labor, more epidurals are provided to these women and the rate of cesarean birth is higher.

Some inductions are started with artificial rupture of membranes, which commits the woman to delivery within 24 hours for fear of infection. Prolapse of the umbilical cord is a risk if rupture is performed before the fetal head has engaged. Women "buy" a package of intervention when they ask for induction. While many women require induction of labor for their own health as well as that of their baby, it should be reserved for those who truly need it.

Women's bodies do indeed function as intended, but in order to do that, we have to give them the chance.

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