I am opposed to inducing labor. I think it's a very bad idea, especially for first-time moms. I was going to try and write as if I'm neutral about it, but I just can't do it.
Let me start my saying that there are some valid reasons for inducing labor. These include preeclampsia, placental age, and illnesses like high blood pressure and kidney disease.
Most women, though, will not have these problems. Most induction candidates are women who induce electively, for reasons like this:
- They're impatient and weary of being pregnant;
- They have gone one day to one week past their due date (the arbitrary cut-off point between waiting for labor and inducing, depends on the care provider);
- They want their baby to be smaller than he or she would be full-term;
- They want to have their baby at a specific, scheduled day and time.
The other most common induction group is mothers who are convinced by their doctors that it is a good idea, in the absence of any medical reason for being induced. This is simply bad practice. Mothers can be easily monitored for signs of distress or to be certain that the placenta is functioning and that all is well. There is no need to induce simply for being overdue, and being induced without medical cause opens up the route for complications, and very rarely avoids them. Mothers should carefully research their options, but arbitrary induction of labor is a route that should be avoided.
To expecting mothers: During your last weeks, you may be recommended to participate in a 'non-stress test' to ensure that the baby is responding to contractions well and that your placenta is functioning - on these days, make sure you eat a meal before you go in for the test. Not eating enough may cause you to exhibit signs of distress and illness that may be misinterpreted and end up in a completely unnecessary induction (high blood pressure, protein in the urine, lack of responsiveness of the baby, all of which will be completely resolved if you simply eat a meal). And, even though you have to pee every few minutes, drink lots of water.
As I have previously mentioned, my first baby was almost 3 weeks overdue (most women, even first-timers, don't go that long). I chose not to be induced because of one reason: I wanted to avoid a c-section. Induction is notorious for being a slippery slope, meaning that if it goes on for a while and doesn't work, the woman will likely be sectioned.
The main reason I am opposed to induction is because it leads to so many interventions and can easily culminate in a preventable c-section. Especially for first-time mothers, I believe that having major surgery is a traumatic entrance to parenthood. I had a natural birth with my first baby, and it was hard enough, getting accustomed to the new and entirely different world of motherhood; I can't imagine what additional hardships I would have had if I had also been healing from a giant surgical cut in my abdomen. Inductions are linked to an increase in the incidence of shoulder dystocia and a higher rate of instrument delivery (here). I hope for better for all mothers, and wish to help mothers avoid unnecessary trauma. Labor is much more gentle for mother and baby, and faster too, when it begins on its own.
I am also worried about the welfare of the babies. Babies born too early, even by a few days, can have trouble breathing, nursing, or sustain injuries. They are much safer in the womb until they are ready to come out and their mothers' bodies are ready to birth them.
The method of induction depends on how ready the mother's body appears to be. If the cervix is effaced and dilating, she will likely have pitocin. If the cervix is not prepared, she will probably have prostaglandin gel applied to her cervix to ripen it. Other methods are stripping or sweeping the membranes (the practitioner uses his or her fingers to manually lift the bag of waters from the lower part of the uterus, trying to stimulate contractions - labor may take a day or two to start, if it's going to at all), and breaking the bag of waters (increases the chance for infection and c-section if the woman's body doesn't start labor within a certain period of time).
Most likely, if the induction has been scheduled, a combination of these methods will be used. (Just as a side note, I found this sentence on a popular baby/pregnancy website: "Some women say that Pitocin causes more intense contractions, but if this is your first baby, you won't know the difference." You won't know if your contractions are unnaturally difficult and intense? Of course you will be able to tell! You just won't know that labor can also be gentle and manageable.)
If the mother is in a hospital and her bag of waters has been broken, she will stay until she has delivered the baby. This means that if the care provider breaks the membranes in an attempt to start labor and it doesn't give the desired results, after a period of time a cesarean will be considered necessary. With the membranes broken, the woman is at risk for infection, and once infection begins, the doctors cannot be certain that the baby is not in trouble also. Maternal fever is considered a problem for both laboring mother and the unborn baby.
If your doctor wants to induce labor by way of cytotec (also called misoprostol or prostaglandin E1, and is in pill form), refuse it and get a new doctor. At the very least don't take it. Cytotec is not approved by the FDA for use on pregnant women; it was originally intended to be used on ulcer patients. It was found to also cause strong uterine contractions. Sometimes it can cause hyperstimulation of the uterus, increasing the chances of uterine rupture and overstressing the baby. One of the problems of using cytotec is that because it is administered in pill form (either swallowed or vaginally inserted), its effects cannot be interrupted once it has been taken. I find the risks far too great for both mothers and babies, and it is unconscionable that cytotec is still being used to induce labor.
It's hard to be pregnant. It feels like forever. Towards the end, when you're as big as a house and it's hard to move around or sleep or eat or sit because your body is half baby, you really long for the relief of labor and birth, just so you can be comfortable again. Both of my babies have been overdue, and I completely understand how difficult the last weeks are.
My midwife assured me, "You will go into labor. Everything is fine, and eventually, when your baby is ready, you will go into labor." It helped to know that I was not defective, that I would not be pregnant forever. The average length of pregnancy for first-time mothers is 42 weeks. That means that some are shorter, and some are longer. Just because the pregnancy lasts 40 weeks and two days does not by itself mean something is wrong. Due dates are estimates. Women who have their labors induced are taking their babies out of the womb before the babies are ready, no matter what the reason. For some situations the risks of remaining in the womb outweigh the risks of being taken from it early. I do not believe, for the sake of mothers or their babies, that inductions should be done electively, as a matter of course, with no medical indication.
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