When you're feeling huge and rolling over in bed requires intervention, scheduling an induction like a hair appointment seems like a fabulous idea. More women are scheduling inductions to start the birth process – in fact, the American College of Obstetricians and Gynecologists (ACOG) reports that 20 percent to 40 percent of labors are now induced. Plus, a recent study seems to indicate that induced birth at 39 weeks has better outcomes for women and children than "waiting it out." But there's a lot to consider before you decide to induce.
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.
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, preeclampsia, 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 Kim Gregory, M.D., vice-chair of the Department of Ob-Gyn Women's Health Care Quality and Performance Improvement at Cedars Sinai Medical Center in Los Angeles.
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.
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 non-medical reasons is a hot topic among experts and moms alike.
The American College of Obstetricians and Gynecologists doesn't recommend induction for non-medical 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."
"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.
Here are some of the popular methods of inducing labor naturally. Are they effective? Decide for yourself!
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 0-3 on five factors, including how far open and thinned out it is. The higher the score, the greater the chance for a vaginal delivery, while totals under 5 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 labor. Pitocin (a drug that stimulates contractions) requires almost continuous fetal monitoring, which decreases a mother's mobility (evidence suggests moving around can speed labor). If labor progresses slowly, her amniotic sac may be ruptured to accelerate the process, increasing the risk for maternal and fetal 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.