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Inducing Labor

Let me begin by assuring that there are some valid reasons for inducing an otherwise healthy pregnancy.

Life-threatening illnesses that will affect the health of mother or baby. These include preeclampsia, severe hypertension, cancer, diabetes, organ disease, or placental age or deterioration.

There are many more reasons women induce their labors to begin:

Suspected large baby. No technology exists to accurately predict the size or weight of an unborn baby. Measurements, ultrasounds, and assessments through other means can be off by several pounds, higher or lower. Even still, women commonly induce out of fear of having a big baby.

Being overdue. Early in pregnancy, women are assured that their due dates are mere estimates; by the end of pregnancy, that has changed, and going past one's due date has become undesirable. I don't think it's a stretch to assume that this is connected with the first. Merely being past the due date, however, is not a medical reason.

Being full-term. This is more common, as women take lightly the act of inducing labor and try to have their babies at an arbitrary time, so long as it's after 36 weeks (and often before 40).

Doctor scheduling. Your doctor has told you that he or she will be out of town at a certain time, and you want to ensure that you are in labor during a time he or she can attend you.

Family scheduling. Many women feel pressured to produce a baby when family will be around. "My mother will only be here for ten days!" "Grandpa will be in town on the 26th, and he'll want to see the baby!" Some women want to give birth so they can attend a family event or go on a scheduled trip.

Discomfort at the end of pregnancy. Your hips hurt. Your belly is huge. You can barely walk or stand up. Sleep is elusive. You're ready to be done. The baby, though, is not.

All of these are inducing for convenience.

Why it matters

Whether or not to induce your labor depends largely on what you want to experience in your labor and what you want to avoid.

As a result of induction you may have:

1. A vacuum or forceps-assisted birth;
2. A baby unable to tolerate contractions.
   

As a result of induction you are likely to have:

1. Increased fetal distress;
2. Pitocin administration, which will make labor contractions stronger and far more painful;
3. Epidural anesthesia to cope with the pain;
   
4. Rupture of your bag of waters, which puts a time limit on how long you will be allowed to labor and increases your baby's and your own chances of infection;
5. Problems with presentation and position of the baby in the womb;
   
6. Increased incidence and severity of jaundice in your baby.
   

As a result of induction you will have:

1. Doubled your chances of delivering by cesarean section;
   
2. A highly-medicalized and regulated birth where you have little or no decision-making power;
   
3. A premature baby. (By premature, I mean a baby born before it is ready; since we do not know when that date would have been, it is safe to assume that all babies born before that point are, to some extent, premature.)
   

The most important part of prenatal care

So, you're pregnant, for the first time -- congratulations!

You go to your prenatal appointments. You're gathering supplies and cute clothing for your little one. Maybe you're picking out the perfect crib, changing table, rocker with matching footstool. You're filled with tender visions of motherhood.

Maybe you can already feel the tiny being moving around inside your abdomen. It's magical.

Your doctor assures you that everything is normal. You continue along in your pregnancy.

As your birth looms closer, your excitement grows. So does the realization that this baby, which seems impossibly huge in late pregnancy, must come out of your body somehow.

You will probably begin to hope that your labor will begin early. This means that not only will the baby be smaller, but you'll spend less time feeling as large (and agile) as a barn. Inductions, stripping the membranes, anything you may be offered at your doctor's office to speed the onset of labor, sound sweet.

What will happen in your labor is an unimportant mystery -- after all, isn't that why you have a doctor? Whatever happens will be fine, because your doctor and nurses will make sure that you come home with a healthy baby, and that is the very most important thing.

..

Except it isn't.

..

You will find that how your baby comes into the world, and how you feel about it, matter tremendously. You might be asked to make decisions you don't understand. You will experience new sensations and emotions and not know if they are normal or aberrant. You might feel afraid, insecure, discouraged, or foolish.

On the contrary, you have the opportunity to experience your birth as a wonderful and normal passage. You can feel comfortable, even in the midst of unfamiliar sensations. You can be confident in your knowledge that you are where you should be, that what you are experiencing is normal and good, and what to expect to come shortly. You can bring your baby into the world, fearless and radiant, with no sense of unease to cloud your joy.

..

Does it depend on whether or not you had an epidural?

Not at all.

All this hinges on your education. Do not miss the opportunity to learn about childbirth. You need to know what will happen, to become very knowledgeable about what is normal and what is outside the range of normal.

Whether or not you choose pain medication does not ultimately matter. You will do what you feel comfortable with, and education may or may not change your course of action in that respect.

But if you arrive at the hospital in labor, are examined and found to be 3 centimeters dilated, and the care practitioner offers to break your waters, what will you choose? There are consequences to early rupture of the waters, not all of which may be disclosed to you in that moment.

If you are told that you need to be induced because of a large baby, what will you say? Do you know how the measurements were made and how accurate they may be? Why does the doctor want to induce for a large baby anyway? Is induction safe?

If the baby's heart rate drops to 100 bpm for a moment, is there something seriously wrong? What will the medical staff do? What does it mean?

Are you prepared to make these decisions?

Do not miss your classes. If you find you still have questions, find out. There are plenty of resources, and for most things, there is reliable, studied information available. Read about birth until you are weary of reading because you know the subject so well.

Prepare yourself.

What happens in your birth, and how you feel about it, matters tremendously.

"I have a doctor; why would I need a doula?"

The roles of doctors and doulas are in different spheres.

Your obstetrician is there to monitor your health and your baby, look for signs of presenting problems or issues, and handle all medical aspects of your care.

When you are in labor, you will typically see your doctor briefly during labor and then when you are pushing out your baby. The doctor is present for a very small percentage of the time you will spend giving birth to your baby.

You will see more of your nurse or nurses (depending on when you are at the hospital, and for how long,, taking shift changes into account). The nurse will come in to check on you, maybe check dilation through a vaginal exam, ask you to rate your pain on a scale of 1-10, take blood pressure, take a lot of notes, and then leave to do it again for however many women are laboring on the same floor as you.

Some nurses are better than others at attending women in labor and giving them help and personalized care. Many have a practical, businesslike approach to caring for laboring women. Some are downright harsh to their patients. Most are too busy.

The hole left between medical visits is what's filled by a doula. Doulas are not medically trained and will not perform vaginal exams to check dilation or blood pressure measurements, but they will remain with you at all times.

Doulas give constant emotional support. They can explain to you what is happening, help you maintain your focus and keep you grounded. They can help with positioning and comfort. They know your intentions and help to communicate them to staff and gently remind you of your goals if needed. They are there to help you have a safe and satisfying birth experience.

This is not the role of the doctor or the nurse. The nurse's priority is the hospital protocol and communicating with the physician. The doctor's priority is the health of the baby and the mother. The doula's concern is your happiness, comfort, and helping you have the birth you want.

No matter what kind of birth you desire, you can benefit from having a doula present. We do not replace the nurse or your partner; we are simply an extra pair of hands and a caring heart to help and encourage you through this amazing rite of passage.