What is induction?
In a pregnancy that is progressing normally, your body and your baby's secrete the hormone oxytocin, triggering labor. This starts contractions and preps your cervix by thinning and softening it. Induction is an attempt to jump-start this process.
Who should be induced?
The medical reasons for inducing are relatively clear-cut -- including preeclampsia, gestational diabetes, an overdue baby, and health risks to your baby. If your health or that of your baby will be at risk if the pregnancy continues, inducing labor or having a c-section may be the best course of action.
If you're at 41-and-a-half weeks of pregnancy, induction is a clear choice, says Leslie Ludka, a nurse-midwife in Silver Springs, Maryland. Past 42 weeks, odds are your baby will be larger, and that can lead to prolonged labor or complications with your newborn.
What about inducing for nonmedical reasons?
Thinking about inducing because your doctor's vacation coincides with your due date or you're just plain tired of being pregnant? According to the Centers for Disease Control, almost 25 percent of all inductions are elective, or not medically necessary. Choosing to induce labor for nonmedical reasons is a hot topic among experts and moms alike.
The American College of Obstetricians and Gynecologists doesn't recommend induction for nonmedical reasons before 39 weeks. Any earlier, and you risk bringing your baby into the world before she's developmentally ready. "Induction is a medical procedure that carries risks, so it should be reserved for medical reasons only," says Sabine Droste, MD, associate professor of obstetrics and gynecology at the University of Wisconsin-Madison.
But she concedes there are nonmedical situations when induction is a viable option. "We get patients from outlying rural communities," she says. "They barely made it to the hospital the first time they had a child, and now they're approaching the due date for their second child. Unless I want them to deliver on the highway, that's someone I want to have come in."
What are the risks of nonmedical induction?
It's tempting to induce to accommodate a busy schedule or to ensure family members are present for the birth. And sometimes you get misleading information that can complicate matters. For example, you may be told that your baby is "too big" and encouraged to induce -- or risk a c-section. However, you should still weigh your options carefully, cautions Mildred Ramirez, MD, associate professor at the University of Texas Health Sciences Medical School at Houston. Most of the time, ultrasound isn't accurate in predicting fetal weight. Your chance of having a c-section because you're inducing before your body is ready is about the same as having a c-section because your baby truly is too big, she explains.
It's best to make the decision to induce after weighing your options and discussing them with your doctor.
How is labor induced?
"If a patient's cervix isn't dilated sufficiently, we have to prepare the cervix by softening it ourselves, usually using the hormone prostaglandin," explains Dr. Ramirez. To start contractions, an artificial form of oxytocin (the hormone that triggers labor), usually Pitocin, is administered intravenously. If you're already showing some signs of early labor, induction is most effective because your body is more primed and ready to go.
Rupturing the amniotic sac, or "breaking the water," is another way to induce labor. The doctor uses a sterile plastic hook to puncture the sac. The amniotic fluid it releases is rich in prostaglandins, which increase the strength and frequency of contractions. But if labor doesn't begin within several hours of this procedure, there's an increased risk of infection to your baby, who is no longer surrounded by the protective fluid.
Breaking the amniotic sac differs from membrane sweeping, where the membranes connected to your uterus are broken. The goal is to make your cervix start effacing and dilating on its own, thereby starting contractions.
There are no guarantees with any of these methods. "No one knows how the mother's body will respond until the induction begins," Ludka says. "It's also difficult to anticipate how the baby will respond to labor, whether artificial or natural, until labor begins." You could have a fast, smooth induction -- or you could have a prolonged experience.
Do natural inducers really work?
Here are some of the popular methods. Are they effective? Decide for yourself!
Walking may help bring the baby into position, with the help of gravity and the swaying motion of your hips.
Nipple stimulation triggers oxytocin, which might start contractions. (However, many doctors caution against this trying this method unless it's under their guidance. Sometimes this can cause prolonged contractions that can cause your baby distress if they're too strong.)
Fresh pineapple contains bromelain, which can help soften the connective tissues of the cervix.
Having sex may work because semen contains cervix-softening prostaglandins.
Eating spicy foods is purported to get your innards rumbling, kick-starting your uterus. But you may just end up with bad gas.
Originally published in the January 2009 issue of American Baby magazine.
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