The Truth About Inducing Labor: What Every Pregnant Woman Needs to Know

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You may have heard about a woman who has had her labor induced by the drug Pitocin simply because her doctor was heading out on vacation. Or perhaps, it was that the expecting mom just couldn’t stand being pregnant any longer.

While the latter seems more justified (if you’ve been pregnant, you can probably relate), inducing labor without a valid medical reason, such as problems with the baby’s growth, medical risks for mom or going way past the due date, is not without its risks. However, a recent survey by the American College of Nurse-Midwives (ACNM) found that 9 out of 10 women wouldn’t mind a labor induction even if there is no medical reason.

Labor induction rates are on the rise. In 1990 just 9.5 percent of U.S. women had labor induced, but by 2008, that number rose to 23.1 percent, according to the American College of Obstetricians and Gynecologists. However ACNM’s survey found that three out of four women did not talk with a care provider about induction during their pregnancy, so therefore it’s likely they don’t know the risks.

A recent study shows that even babies born just a few weeks early and not considered preterm have a higher risk of poor health, including problems with asthma, than those born later. The study, published this spring in the British Medical Journal, analyzed more than 14,000 children born in the United Kingdom who were either late preterm babies (born at 32-36 weeks) or early term (37-38 weeks) and found that babies born at 37 or 38 weeks required readmission to the hospital in the first few months more often than full-term babies (39-41 weeks).

When commenting on inducing labor without medical necessity, ACNM President Dr. Holly Powell Kennedy, a professor of midwifery at the Yale University School of Nursing, says that the problems is the baby’s readiness for being born.

She uses the analogy of berry picking: “Anyone who has picked berries, they know that a berry that is ripe falls into your hand. One that is not quite ready leaves parts on your hands and one that is not ready at all is green. Like a berry, a woman’s uterus and specifically her cervix, ripen as she gets ready to open or dilate.”

A study of nearly 8,000 women sited in the July 2010 issue of Obstetrics & Gynecology found that inducing labor more than doubles the risk of having a cesarean delivery. Powell Kennedy attributes this higher risk to additional interventions and limited mobility. She says, “Most spontaneous labors build up gradually, while an induced labor starts with hard contractions either way.”

She says this leads to the use of continual fetal monitoring (which has been linked to increased cesarean rates as compared with intermittent monitoring), the use of pain medication and the resulting lack of mobility of the mother. “If you stub your toe, you don’t just stand there, you hop around to try and make yourself feel better,” says Powell Kennedy. When you can’t cope with pain on your own, medications become more necessary.

So what can an expectant mother do?

Have a candid conversation with your health care provider. When meeting with a prospective obstetrician or midwife, Powell Kennedy recommends asking the following questions:

What percentage of women you work with have their labors induced?

What are your reasons for inducing before 41 weeks?

The best option with a healthy pregnancy is to let your baby tell you when it’s time. On coping with the impatience, Powell Kennedy says, “It’s worth the investment to completely pamper yourself in the last weeks of pregnancy. Nourish the body and soul as best you can. And engage the whole family in helping you get through those final weeks.”

When you’re feeling huge and miserable and rolling over in bed requires intervention, scheduling an induction like a hair appointment seems like a fabulous idea. But there’s a lot to consider before you consent. That’s because experts agree on the large role failed inductions play in the ever-increasing Cesarean section rate—a record high of 31 percent in 2006.

The American College of Obstetricians and Gynecologists (ACOG) reports that 20 percent to 40 percent of labors are induced—a number that, along with C-section rates, has doubled in the last decade. A 2005 ACOG study determined that inducing first-time mothers was directly associated with an increased risk for C-section: The rate was 12 percent for spontaneous labor, 23.4 percent for medically indicated inductions and 23.8 percent for elective inductions.

Other complications can stem from the fact that due dates are notoriously inaccurate. The same is true for predicting a baby’s size: Inducing for a suspected large baby actually increases C-section risk. What’s more, a fetus’s lungs are among the last organs to develop; scheduling an induction before 39 weeks may result in delivery of a newborn who needs to spend time in the neonatal intensive care unit (NICU).

Who Should be Induced? 

Sometimes, inducing labor is the safest thing to do. 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.

Elective inductions, on the other hand, are scheduled for convenience—to eliminate messy schedules, middle-of-the-night deliveries and late-pregnancy discomforts. Many experts speculate that up to 50 percent of inductions are elective.

Your Body Must be Ready. 

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.

Weigh Risks vs. Rewards 

Although many doctors schedule inductions at 38 weeks, the increase in failed inductions, maternal and newborn infections that result from the membranes being ruptured prematurely, C-sections and NICU admissions has led to stricter guidelines. ACOG states that elective inductions shouldn’t happen before 39 weeks unless the baby’s lung maturity is determined by amniocentesis. Regardless, elective inductions often happen earlier.

Making the decision to induce requires thoughtful consideration. Sometimes, it’s just not worth taking a shortcut. “If there’s a medical indication, that’s a no-brainer,” says Karen Parker-Linn, a certified nurse midwife in Portland, Ore. “The benefit outweighs the risk. But if a woman’s not ready, I won’t induce. I’ll ask, ‘If your baby’s in the NICU and they’re poking him with yet another IV, was your discomfort more important than preventing that?'”

15 Things Pregnant Women Need To Know About Induction

15 Pump Mom With Hormones

As the time for you to go into labor draws closer, your cervix will begin to open up naturally on its own. If the cervix shows no sign of ripening, the doctor may help you out by giving you hormones known as prostaglandins, to induce labor. Prostaglandins in women help to regulate the reproductive system by controlling ovulation and starting labor. These hormones will work to dilate, or open the cervix, as well as soften and thin it out; the thinning of the cervix is known as effacement.

The hormones can be applied to your cervix as a topical gel or in the form of a vaginal suppository. After a few hours, your cervix will be checked. Usually, this treatment is enough to get labor started.

Be aware that if you’ve had a C-section in the past, the doctor likely will not use this treatment, as it can increase the risk of uterine rupture.

14 Sweep Or Strip Mom’s Membrane

The doctor may decide to induce labor by stripping or sweeping the membranes. In this procedure, which can be done in the doctor’s office, the doctor will use a finger to gently separate the amniotic sac from the wall of the uterus. This will release the hormones that can trigger contractions and cause the cervix to soften and open. In some cases, the doctor may also gently stretch or massage the cervix to help with effacement and dilation.

After the procedure is completed, you will probably be sent home to wait for contractions to begin. The stripping of the membranes isn’t exactly pain-free, and you may have cramping and spotting. While stripping or sweeping the membranes isn’t meant to break your water, sometimes that can happen.

Studies have found that there don’t appear to be any increased risks for negative side effects if a woman has the stripping/sweeping procedure done. Women who have the procedure aren’t any more likely to experience any delivery complications or need a C-section

13 Take A Walk

Going for a long walk is good exercise, but some doctors question whether or not it really helps bring on labor. And while the act of walking may draw baby down into your pelvis (thanks to gravity and the movement of your lower body) it might be a good idea not to overdo it. If you do end up going into labor, you don’t want to be exhausted! You’ll need all of your energy to push out that baby!

If your contractions have already started, walking might help your labor progress. The pressure of your baby on the cervix might help speed things along. It’s also possible that spending time in an upright position can help ease the pain of labor as well as shorten your labor.

You know how you’re not supposed to sleep on your back when you’re pregnant? Lying on your back for long periods of time during labor isn’t a great idea, either. It can compress the blood vessels in the lower part of your body, which can compromise blood flow to your baby and possibly cause his heart rate to drop. If you stay upright, or at least off your back, placental circulation can improve and fetal heart rate may stabilize.

12 Artificial Water Break

If your cervix has begun the process of dilation and effacement on its own, but your water still hasn’t broken, the doctor might jump start your labor by breaking your water for you. This is known as ARM – artificially rupturing the membranes. Usually, the strength of contractions will place enough pressure on the amniotic sac to break the bag of waters, but if the doctor feels that you need some help, he can step in and do it manually.

The doctor will use a tool that looks like a long crochet hook with a sharp tip to puncture the bag of waters. It might be uncomfortable, but it shouldn’t be painful. Once the procedure is done, contractions may start, or they may start coming stronger and faster. You may feel a gush of fluid. Because the uterus keeps making amniotic fluid up until the baby’s birth, you may continue to feel fluid leaking, especially after a strong contraction.

11 An IV Of Pitocin

If the doctor has attempted induction with hormones or the stripping and rupturing of the membranes, and you still aren’t having regular contractions after awhile, the doctor may then give you the medication Pitocin. Pitocin is the synthetic form of the hormone oxytocin, which stimulates contractions.

An IV will be inserted for the Pitocin to be administered. The medicine is given in a small dose at first, and then the dosage is gradually increased until contractions begin coming every two to three minutes. The Pitocin can be left on until you deliver, adjusted if your contractions slow down or taper off, and can be shut off altogether.

Contractions tend to start about a half an hour after the Pitocin is administered. The contractions are usually stronger, more regular, and faster than contractions where labor has begun naturally. If you’re thinking about getting an epidural, you might want to ask about getting that going so that it’s in place once your labor really does start.

10 Catheter Insertion

The use of a Foley balloon catheter for inducing labor isn’t as common as it’s used to be, but it’s considered an option for women who aren’t good candidates for induction by medication. The balloon portion of the catheter is inserted (while deflated) into the uterus. The doctor will find your exam either visually or with fingers to make sure that the balloon is placed between the amniotic sac and the lower part of the uterus on the other side of the cervix. The balloon is inflated with a saline solution and then left in place, which will cause the cervix to expand.

The purpose of the catheter is to start labor, but sometimes it helps make the cervix more ready for induction by Pitocin or having the doctor break the bag of waters. Even if the catheter alone doesn’t jump start labor, many women will give birth within 24 hours of insertion.

9 Do Natural Methods Actually Work?

While there are quite a few surefire ways for a doctor to induce labor, there are also some natural methods that you can use in an attempt to kick start labor yourself. Some of them might just be old wives’ tales, but people claim they work. But while some of these strategies may appear to be successful, it’s hard to tell if they really helped jump start labor, or if it was just a coincidence and it was time for labor to start naturally on its own!

If you’re over being pregnant and are done with the bun in your oven, you might want to start trying anything to get labor started. However, you want to talk to your doctor before trying any of these methods at home. You might be ready to carry that baby in your arms instead of in your belly, but it’s better to discuss your options with your doctor first. If the doctor gives you the go-ahead… then go for it!

8 Getting It On

If you’ve made it to week 40 (or 41 or 42) in your pregnancy, having sex might be the last thing you feel like doing.  It might also take some flexibility and some gymnastic maneuvers to pull it off. However, there are some doctors who might suggest getting frisky to help start labor.  It’s not the motion of the ocean that gets things going. Sperm contains prostaglandins, the hormones that help start labor by stimulating the cervix.

Both men and women worry about whether or not sex is safe during pregnancy. The thing is, it’s perfectly fine to have sex throughout your pregnancy, even as your due date nears. If you’re really concerned, ask your doctor his opinion. Chances are, he might tell you to go for it!  It might be awkward and uncomfortable, but it’s a good way to relieve some tension and strengthen your bond as a couple – before the third wheel comes along! And if it kick starts labor, that’s a bonus!

7 Nip Stimulation

If you are actually in the mood to get a little frisky (or you just really want to be done with your pregnancy) be sure to add nipple stimulation (massaging or twisting the nipples) to your bedroom activities. Nipple stimulation can cause a release of the hormone oxytocin. (This happens during breastfeeding, too.) Pitocin is the synthetic hormone that is given to induce labor, so if you can get the real thing flowing, there’s a possibility it could work!

There are a couple downsides. For starters, it may actually take awhile to get your body to release oxytocin. The other downside is that doctors don’t usually suggest this method because it can cause painfully long and strong contractions that could possibly lower the baby’s heart rate. Unless your doctor suggests this method, it might be best to keep your hands (and your partner’s hands!) off. Besides, once the baby arrives and starts looking for food, your nipples will be getting plenty of action.

6 Herbal Remedies

Many women turn to herbal remedies as a way to start labor. Before taking any herbal supplements, always discuss the risks and benefits with your doctor. The FDA does not regulate herbal supplements, so the potency of herbs may vary from manufacturer to manufacturer. In addition, some herbs may become toxic when taken with other herbs or medications.

Some women have used evening primrose oil to because it contains prostaglandins to help thin the cervix and dilate it for labor. You can take evening primrose capsules, rub the oil into cervix, or even insert the capsules into your vagina. However, women with placenta previa should stay away from it.

Another herb that some women use is black cohosh. This herb is thought to help prepare the uterus for contracting during labor. Doctors warn that the chemicals found in the herb may act like estrogen in the body, throwing hormones out balance.

While red raspberry leaf tea doesn’t really do anything to soften the cervix, it is thought that this herb can help improve the efficiency of uterine contractions, which will help shorten the pushing stage of labor.

Not many studies have been done to determine the safety of herbal supplements in regard to pregnancy and the health of the baby. Don’t use any herbs without first discussing it with your doctor.

5 Accupressure/Massage

Similar to acupuncture (minus all the little tiny needles!) acupressure is the practice of applying pressure to certain points of the body. Pressing on these points may stimulate uterine activity and bring forth contracts. There are two acupressure points thought to help wake up your uterus and get it contracting.

The first one is the webbing in between the thumb and index finger. The other spot is found on the inside of your leg, about four finger-widths above your ankle bone. There are other spots on the foot that are thought to help stimulate labor as well, so maybe it’s time to go get a pedicure and enjoy a nice foot massage!

You can also try having someone massage different spots on your next and back. One spot is in the lower back, above the buttocks Another area is on the large muscle between the neck and shoulder. If the massage doesn’t initiate labor, at least you’ll feel a little more relaxed!

4 Spicy Food

Some women really believe that spicy food can irritate your intestines enough to cause your uterus to begin contracting. There’s no evidence that proves that spicy foods can really bring on labor, but if you’re craving some jalapeno hot wings or some extra-spicy tacos , there’s no harm in trying. Just remember to bring some antacids with you to the restaurant – you might bring on a case of heartburn before you bring on labor!

For awhile, eggplant Parmesan was thought to be another dish that could get things moving. If anything, it’s the herbs and spices used to flavor the dish that might have helped get things going for a few lucky ladies.

There’s even a restaurant in Los Angeles, California, that has a salad on the menu that has been thought to help many pregnant ladies go into labor for the past 28 years! The salad is pretty simple: romaine lettuce, watercress, walnuts, and Gorgonzola cheese. But could there be  something in the sauce? A lot of women believe it’s the balsamic basil vinaigrette that does the trick!

3 Pineapple

On the other end of the taste spectrum, some women swear by eating sweet pineapple to induce labor. Pineapple doesn’t necessarily start labor, but it is thought that the enzyme bromelain, which is found in the fruit, can help ripen the cervix and prepare it for dilation and effacement.

The heat involved in canning and juicing fruits destroys the enzyme, which means you can’t drink bottled pineapple juice or eat chopped pineapple from a fruit cup or can. You have to eat fresh pineapple, and you’d probably have to eat a lot of it for it to really do anything because bromelain is found in such small amounts in pineapple.

On the downside, eating too much pineapple can cause heartburn and diarrhea. While it’s not a sign for every woman, diarrhea can also be considered an early indicator of impending labor. Think of it as nature’s way of emptying everything out to make some room for baby’s entrance into the world.

2 Castor Oil

This natural method of inducing labor could have you running for the bathroom before it has you heading for the delivery room. Castor oil is a vegetable oil that acts as a laxative. If you take a dose of it, it will stimulate the bowels and cause spasms in the intestines, which in turn, can irritate the uterus and cause the uterus to begin contracting. But if your body really isn’t ready to go into labor, this method might just give you a case of diarrhea, nausea, and vomiting. This could end up leaving you dehydrated, especially if you take too much.

Talk to your doctor before trying castor oil. Your doctor may have reasons for you to skip it, or he may give you the green light to try it. Just be sure to take the recommended dose, drink lots of water to stay hydrated and try taking it first thing in the morning – so you’re not spending the night in the bathroom!

1 Risks Of Induction

Inducing labor is safe, but as with any medical procedure, there can be some risks. These include:

Higher risk of a C-section. If induction doesn’t work and labor stalls, the doctor may suggest a C-section instead.

Low fetal heart rate. Some of the medications used to induce labor, like Pitocin or a prostaglandin, might cause too many contractions which can lower both your baby’s heart rate and oxygen intake.

Increased risk of infection. Some methods of inducing labor, such as sweeping or stripping the membranes, artificial rupture of the membranes, or using a catheter in the cervix might increase the risk of an infection for both mother and baby.

Bleeding after delivery. Having your labor induced can increase the risk that the uterus won’t properly contract after giving birth, which can result in heavy bleeding after delivery. Just like it’s used to help start labor, Pitocin can be administered to help with uterine contractions after delivery.

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