Is an Induction Necessary?

What is an Induction?

Simply put, it is a method - caused by drugs or some natural means - that "brings about or causes" you to go into labor - whether your body and your baby are ready or not.

Dr. Gemmer describes inducing this way:

Remember that just like your unique fingerprints, all women birth differently. We cannot - and must not - assume that we should all birth the same way...this assumption has been to the detriment of women and their babies.

Let's look at it another way...think about this: you want to bake a cake and the box says 50 minutes at 375 degrees Fahrenheit. Now, when the timer goes off, if the cake is still "wet" in the middle, you shouldn't just take it out because that's what the box said. Common sense says, maybe it needs a couple more minutes. My oven is different than your oven and most ovens will produce different results. Now, your baby is not a cake, but we often jokingly refer to pregnancy as having a "bun in the oven" - so let's not rush the "cake" just because the "box" says so...

The 40 week mark is not a deadline but rather a guideline - or at least that is the way it should be.

Now, let's get down to business.

Medical Reasons for an Induction

This quote by Helen McDonald, Professor of Midwifery at McMaster University in Hamilton, Ontario, was found when researching induction and while it makes sense in one aspect it is also truly disturbing and very dangerous.

So are there valid reasons for an induction?

The answer to this is yes there are. In a perfect world no one would get sick and birth would always be without issue. You know as well as we do that we do not live in Utopia. However, medical interventions should be restricted to the absolutely necessary category rather than for "convenience," fear of lawsuit, being bullied into it, "my doctor is going on vacation" or "I am so sick and tired of being pregnant."

There are situations where an induction is medically necessary - such as for a drug addicted mother or if your baby is failure to thrive. HOWEVER, to make a statement that sounds like a generalization of all women, it is truly troublesome. This particular article reads like the reasoning for induction was due to the mother's malfunctioning or incapable body. Remember than if women are left alone to birth...97% of the time all goes well.

When researching about inductions, you will find a slew of reasons in favor of it. According to the medical literature, you "should" induce if:

You have complications such as high blood pressure, baby is too big or too small, diabetes, preeclampsia - just to name a few.

Pre-mature rupture of the membranes - broken water

The placenta is no longer functioning properly, too little amniotic fluid, or your baby isn't thriving or growing as he should

Post-term pregnancy

Psychosocial reasons

Previous full-term stillbirth

If you must be induced, the Bishop score should help determine if your induction can/will be successful.

An Induction: What are the Facts?

True complications make up about 33% of inductions which would mean that 2/3 are unnecessary. Let's take a closer look at the reasons given above.

Chronic or Acute Illnesses

Chronic or acute illnesses - such as high blood pressure, diabetes, or kidney disease - that threaten your health or the health of your baby can mean that you should be induced - but not in all cases. These conditions can be controlled to some extent. A mother has a responsibility to take care of herself through sound nutrition and exercise.

High blood pressure accompanied with edema and/or protein in the urine is called preeclampsia - or toxemia. It is a serious condition that can endanger your health and the health of your baby. In fact, it can be deadly. If this condition cannot be kept under control, the only "cure" is for the baby to be born. If there is time an induction will be performed, if the condition is too serious an emergency c-section will be done. In this case, an induction is valid.

Baby is too big

That reason is used a lot, it is even used to justify unnecessary c-sections. Know that the head circumference of a 7 pounder and the head circumference of a 9 pounder is just about the same. And the head is the "hard" part to birth. Moreover, no one can predict how much your body will spread and the amount of molding of your baby's head will do. A well nourished mother can birth the baby she nurtured whether he is 9 pounds - or more - unless she is made to believe somehow that her baby and her body are a freak of nature. You must know that the number one reason for an induction is what we call defensive medicine - which in short means "cover the doctor's rear." Even ACOG - American College of Obstetricians and Gynecologists - is against inductions unless medically necessary.

A SGA - small for gestational age - or IUGR - internal uterine growth retardation - can be cause for an induction. The placenta and the baby should be monitored closely. But you must be aware that these conditions can only be truly diagnosed AFTER your baby's birth and that ultrasounds CANNOT be the only factor a decision is based on since they are very unreliable for fetal weight determination. If you suspect SGA then follow the Brewer Diet to the letter and make sure you eat nutritious foods. If over time it is determined that indeed baby is not doing well, an induction or a c-section will be performed.

Premature Rupture of Membranes

Pre-mature rupture of membranes is also referred to as PROM. The medical establishment says that this is cause for an induction because once the protective sac is broken, it's possible for the bacteria in your vagina - and your rectum - to reach your baby and to cause a potentially serious infection. What's not clear is how long it is safe to wait for labor to begin on its own.
Midwives know that in such cases moms who do not have a fever and do not receive vaginal exams can - and do - go on for days before labor starts. At times, it has been documented that the bag can re-seal itself. Remember, your baby and your body makes amniotic fluid daily!

The funny thing we discovered though is that if your baby is still very premature, it is recommended that you not be induced. Does this mean that preemie babies are less susceptible to infection or that inducing in the first place is not necessary unless other factors indicate that something else is amiss?
It is not like as soon as your sac is broken bacteria decides to just climb on up the birth canal and infect the baby on their own. The chances of infection increase dramatically with each vaginal exam that is performed - that is a FACT! So if this happens to you tell your care provider to keep his hand out unless your baby is high and not engaged and there is the threat of a prolapsed cord.

If tests do show that your placenta is no longer functioning properly then yes you may need to be induced. IF a mother is taking care of her body and baby as she should, she minimizes the chances of any "wrong" occurring. Remember though that even diet, exercise and doing "everything right" cannot guarantee that all will be well. Indeed, there are no guarantees in life - except for death and taxes. But a nutritious diet and moderate exercise has been proven to be the very best pro-active behavior - and dare we say defense - that you and your baby have.

Post-term Pregnancies

Post-term pregnancies which are defined as lasting 42 weeks account for another large percentage of inductions. Most doctors nowadays will call you post-term at 40 weeks. Research suggests longer-lasting pregnancies are slightly more likely - about one additional chance in 1,000 - to end in stillbirth.

The most compelling piece of evidence the induction side has is a Canadian study published in The New England Journal of Medicine a decade ago. When comparing more than 1,700 women who were induced for postdate pregnancies to a similar number who were merely monitored, researchers found those in the induction group were slightly less likely to undergo a c-section. Of the women who were induced, 21.2 percent eventually delivered by C-section, versus 24.5 percent of those in the monitored group. That is hardly statistically significant enough to justify an induction when induction themselves are KNOWN to increase your chances of a C-section. Moreover, can we attribute the 3 point difference to inductions? That's it? That's compelling evidence?

HOWEVER, fetal distress was detected more often in the women who were monitored. This finding can be interpreted in two different ways: Some doctors believe that the longer your pregnancy continues the greater the likelihood that your placenta will begin to malfunction - again a generalization of your incapable body - triggering fetal distress. On the other hand, women in the "wait and see" group may have been monitored more closely, and the more tests that are run, the greater the odds of getting an abnormal reading - even if everything is perfectly fine. Placental insufficiency is rare and is NOT related to a date. The placenta can begin to fail at any point in pregnancy and good prenatal care is the way to ensure all is well.

Here are some FACTS on postdates:

Being overdue with no other factors has never been associated with a poor outcome. Now being overdue AND having poor fetal growth and/or abnormalities does show an increased risk of stillbirth. So let's go over this again: overdue to 43 weeks with no other factors no increased risks. And you must be told this: the data to validate inductions after 40 weeks was collected in 1958 at a time when women were severely medicated during labor. Who is to say baby did not die from overdose rather than the birthing process! Furthermore monitoring was just about non-existent.

On the other end, newer statistics show an almost flat rate of stillbirth from 40 weeks to 42, with a slight rise at 43 weeks - all numbers being close to 1/1000 (Gail Hart - A timely Birth). If by now, you are thinking the medical profession is overreacting about the 40 week "deadline", we would agree with you!

Yes, stillbirths increase dramatically AFTER 43 weeks but on the other hand less than 10 percent of babies will show signs of post-maturity syndrome after that time, the other 90% are perfectly fine.

Since - as you will see later - an induction is far from risk free, why not monitor women and induce only if indicated - not just because the "timer" went off! Many large and valid studies have demonstrated that careful monitoring while waiting for labor to start on its own results in fewer c-sections without any rise in the stillbirth rate.

Psychosocial Reasons

In rare cases, factors other than your physical health or that of your baby drive the decision to start labor. Some examples include:

a woman whose labor was induced to allow her terminally ill husband to see the baby before he died

others include scheduling birth around the availability of a female caregiver for a woman who's experienced sexual abuse.

It should not include "so sick of being pregnant" or "my doctor is on call tonight." Remember an induction is not risk free!

But now the questions that remain to be asked are: is an induction risk free and is it safer than spontaneous labor? To find the answers to these questions Click Here.

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