I recently had a conversation with a patient who needed an induction of labor for a medical reason affecting the safety of her and her unborn child. I explained the circumstance to the patient and she seemed to understand. Shortly after she left my office she called back. She had talked to a friend about what was about to happen and her friend told her not to do it because she was going to end up with a c-section.
“Doc, we’re going to have to induce you.”
They were talking to me. I was “Doc.” I was 36 weeks with my first child. If you are interested in learning more about my birth story, click here. But do it AFTER you read this one, lol. You just got here.
Yes, I was induced with my first and my third pregnancies. And yes, I delivered all of my children vaginally. I don’t say “naturally” because All Birth Is Natural. But my point in starting off this article with that information is actually my first reason why you shouldn’t fear being induced.
One: Induction doesn’t equal c-section.
What is induction of labor? Induction of labor, also known as being “Induced” means that you receive medication and sometimes procedures to start labor. It could include medication to dilate or open the cervix, physical dilation of the cervix with a balloon, breaking the bag of water and often Pitocin, a medication the mimics our own bodies Oxytocin which causes contractions to occur.
A lot has been said in the news, and literature over the years about inductions increasing a person’s risk for having a c-section. Hearsay from family and friends can also add to a person’s concerns about medical intervention. Here are a few facts about induction of labor as it relates to c-section.
-> Seventy-Five Percent of people whose labor is induced have a vaginal delivery. (https://www.mayoclinic.org/tests-procedures/labor-induction/about/pac-20385141)
-> C-section rates are lower in people who are induced at 39 weeks as compared to people who remain pregnant and wait for spontaneous labor. (https://www.nih.gov/news-events/news-releases/induced-labor-39-weeks-may-reduce-likelihood-c-section-nih-study-suggests)
And while I don’t make it a point to induce people at 39 weeks without cause, if life or logistics warrant it, I don’t discourage people who make that decision, as long as the understand the risks.
Two: If an induction is medically indicated, the benefits often outweigh the risks.
Take my own circumstance for example. I was induced at 36 weeks because I developed severe preeclampsia (now known as preeclampsia with severe features for the medical professionals in the room). Preeclampsia can be life-threatening for mom and baby. No, my body wasn’t ready, but our mutual safety rested on getting this baby out of my body.
With my third child, I was induced because I had developed cholestasis of pregnancy. I was 37 weeks that time. Again, not ready but cholestasis is a condition that can lead to stillbirth without notice or abnormal signs. It was super important for her to be delivered as soon as she was old enough to be outside of me safely and at term.
While both of those scenarios seem super dramatic, most of the time when your doctor suggests an induction (speaking for myself), it is because something is happening with you or your baby that makes delivery safer than staying pregnant. Some indications could be diabetes, high blood pressure, age over 39, preeclampsia, if the baby is too small or isn’t growing normally, if the baby has too little fluid. These are just a few examples. If you are unsure of what the reason is that your doctor offers an induction, ask them. You deserve to know and understand the reasons.
So what are the risks of induction?
Risk can include increased blood loss, infection, and c-section in 25% of inductions. Those risks vary based on how dilated a person is at the start of the induction, as well as the overall health status of mom and baby at the start of the induction. Remember, there are multiple reasons why a person could end up with a c-section, most of which are not related to how the labor starts or is started. Read more about things you should know about c-section here.
Three: Waiting for spontaneous labor comes with it’s own set of risks.
Keep in mind, the baby doesn’t decide when they are ready to come out. If babies actively and conciously made that decision, people wouldn’t go into preterm labor. I think that that fact is important because some people will stay pregnant well beyond their due date. They do that, not because baby isn’t “ready” but because the sequence of events/hormones etc to start their labor hasn’t started.
As a person waits beyond their due date for labor to commence, a few things are happening. Their placenta is getting older and possibly less functional. Their risks for developing hypertension and preeclampsia in the pregnancy begin to rise, and babies can start to get less oxygen.
We don’t let people go beyond 42 weeks (2 weeks past the due date) because then they are at risk for something called “Postmaturity” syndrome or Postterm Pregnancy. Babies are at higher risk for:
- Stillbirth
- Large birth weight
- Malnutrition
- Meconium aspiration
- C-section due to size and inability to tolerate labor
In my practice, as long as monitoring is within normal limits, I will let people stay pregnant into the 41st week, but I am ready and willing to induce before 42 weeks because of the above.
Four: In the age of COVID-19, planning can play a role, especially if a person has other children in the home.
Sometimes, an induction is offered just so that all parties know where they’ll be. With COVID-19, children are almost universally not allowed at the hospital. And while first babies can take hours to days to come out after labor starts, sometime second or third babies come out in the kitchen or on a highway because it is so fast. Prep time to get childcare and get to the hospital in a pinch is more challenging for some.
I almost always at least discuss induction with my second or third time moms who have delivered vaginally in the past, simply to relieve some of the anxiety of what they’ll do with their first child. Most want their partner in the room too. Planning can sometimes help make that more feasible.
Five: Regarding pain, inductions aren’t necessarily worse than spontaneous labor. All labor hurts.
Speaking from experience, I can’t say that my second labor, which started spontaneously, wasn’t any easier or less painful that the ones before or after. Keep in mind, some people gradually go into labor over hours or says. I’ve had ladies begin to experience labor pains on a Monday and not deliver until Friday or Saturday. Inductions don’t usually take that long so the intensity of contractions may ramp up over a matter of hours, rather than days. Regardless, labor hurts.
Some make the argument that Pitocin makes things so much worse. Think about it like this though: I only give Pitocin to a person whose labor isn’t progressing on its own. If the labor isn’t progressing, meaning you aren’t dilating or contracting regularly, the contractions are likely not strong enough or frequent enough to allow labor to progress. Of course Pitocin is going to make things hurt worse because it makes contractions stronger and more frequent. With my second baby, I didn’t need pitocin and I progressed fine on my own, but that $&#$ HURT!
Mild labor isn’t a thing.
Pitocin may be the method to getting a person in labor, but it is the contractions that are causing all of the pain. If pain freaks you out, plan for an epidural. But I personally think it is unrealistic to think a human will come out of your body and it’s not gonna make you cringe, with or without Pitocin.
In conclusion, if your doctor or provider offers you an induction, the first thing I would want to know is why. You can elect for an induction (meaning ask for one even without a medical reason), but you should also know risks, benefits and alternatives or that decision as well.
Ask questions. Get a clearer understanding. But I’ll tell you what you shouldn’t do. Don’t just listen to Dr. Google or your play (or real)-Auntie when it comes to making decisions for yourself or your unborn child.
The Gyneco-(b)Logic 