Evidence and Hype: Understanding the Motives Behind Labor Induction

Natural Hospital Birth

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Your provider is suggesting an induction toward the end of your pregnancy. So what do you do?

You ask, “what’s the rush?”

 

Before consenting to any intervention, we need to be uber clear on the WHY. Is the reason for an induction an evidence-based one? In other words, is it medically necessary and will it improve outcomes for mother and baby?

 

Below is a list of common reasons doctors give for inductions, with zero evidence backing them up:

  • Suspected big baby
    • There are plenty of women who have confidently birthed larger-than-average babies without any complications (or tearing). Your body wouldn’t grow a baby that it can’t birth naturally. Let’s not forget that the ultrasound technology that doctors rely on to determine baby’s size is wrong 50% of the time.
  • Due date
    • Going into labor 2 weeks prior or 2 weeks after your ‘guess date’ is usually not a concern. The average timeline for first-time moms is somewhere between 40 weeks and 5 days and 41 weeks and 2 days. If the lungs are the last thing to develop, shouldn’t we be grateful for reaching or surpassing what’s defined as ‘full term?’ 
  • Hospital policy
    • These policies are in place for the staff, not the patient. Your doctor’s comfort level with physiological birth carries some serious weight too. I’m here to remind you that informed refusal is just as important as informed consent. It can take 16+ years for evidence-based research to make it into standardized practice. Let that one sink in. 
  • Water breaks after 37 weeks, and you’re GBS positive
    • We know if you have healthy vitals it’s perfectly safe to wait an additional 2-3 days for labor to kick in on it’s own. Don’t let anyone tell you that your GBS status is enough of a reason to induce. It is a great reason to refuse all unnecessary cervical checks though! I was GBS positive. I allowed labor to unfold on its own (I even refused antibiotics) without complications.
  • Low amniotic fluid
    • There’s no proof that kickstarting labor for isolated oligohydramnios (low fluid) at term does any good for moms or babies. Any suggestion to induce labor for this reason would be a shaky recommendation.
  • The ARRIVE trial
  • Waters rupture, but contractions haven’t started yet.
    • So what? Labor is going to start with either contractions or your water breaking. These two events can happen hours or days apart. Here’s where mindset work can be super helpful. Check out my free guide here to help you calm those anxious vibes. 
  • You’re 35 years or older
    • Geriatric pregnancy, advanced maternal age…blah blah blah. Healthy moms who have already given birth carry even fewer risks. Not only is having babies after age 35 becoming way more common, but it has some serious benefits. I don’t regret waiting until I found myself, had a steady income, could afford great health insurance, developed an incredible support system, and prioritized my health before starting my family. We can all agree that there is very little black and white in the birth world. So we should also talk about the gray areas of induction.

Here are a few legit reasons to agree to an induction that actually have some solid evidence behind them:

  • Too much amniotic fluid
    • If this becomes a concern you can opt for medication or to undergo a drainage procedure. Induction is rarely your only option Mama. 
  • Going postdates (42 weeks +)
    • The #1 reason this makes providers uncomfortable is the risk of stillbirth, which increases to 32 babies out of 10,000 at 42 weeks gestation. But what if your due date is off? Outside of the dating ultrasound, we follow a 28-day menstrual cycle to estimate due dates. My cycle is 31 days.
  • Intrauterine Growth Restriction (IUGR)
    • IUGR is a condition when the baby doesn’t grow to normal weight during pregnancy. It can be a true cause for concern and additional monitoring. Because of the high rates of false positives, it’s super important that you get confirmation that the baby is struggling and needs intervention before making decisions against your birth plan.

If your doctor is pushing for an induction based on the reasons above don’t hesitate to slow down and throw in some follow-up questions. Trust your gut, and question whether it could just be a natural variation in fetal development and birth. 

 

Now, let’s talk about the reasons firmly grounded in evidence I support. Reasons which we should count our lucky stars and practice gratitude for advancements in medicine.

  • Uncontrolled Gestational Diabetes
    • When GD becomes unruly it can increase mom’s risk of cesarean section and postpartum hemorrhage, as well as increase baby’s risk of jaundice and breathing issues at birth. Gestational diabetes affects about 7% of pregnant women in the US. GD is usually very manageable with lifestyle adjustments or medication. 
  • Pre-Eclampsia
    • High blood–pressure in pregnancy requires close monitoring. When paired with constant headaches, swelling, or protein in the urine, it can become very dangerous. 
  • Cholestasis
    • A condition marked by itchy hands and feet, yellowing of the skin, loss of appetite, nausea and high levels of bile acid. Patient treatment is delivering your baby. 
  • Chorioamnionitis
    • An infection of the membranes, or chorioamnionitis, happens to about 2% of pregnant moms. Unfortunately, a common cause of these infections is the failure of providers to wash their hands well enough before performing my favorite…………cervical exams. Fever must be present to get an actual diagnosis.
  • HELLP syndrome
    • Hemolysis, elevated liver enzymes, and low platelets, or HELLP, is a variation of Pre-Eclampsia that occurs in 15% of all Eclampsia cases. Delivery of the baby is the treatment.
  • Placental Abruption
    • This is when the placenta detaches from the lining of the uterus. It is usually followed by vaginal bleeding and requires close monitoring of the baby. This is a serious condition that happens in about 1% of pregnancies. 
  • Personal health conditions
    • Certain medical history, such as kidney disease will require an induction before your due date to keep you, your kidney, and your baby safe. 

 

The whole induction discussion is seriously intricate. When my clients approach me to support their goal of a natural, unmedicated birth, I’m all in to make it happen. My commitment lies in assisting women to assert themselves and say no to interventions they don’t need. On the other hand, when induction becomes a medical necessity, we can collaborate to adapt our initial plan, maintain control, and still feel empowered throughout the process.

-Coach Lisa V

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References

Clinical guidance for integration of the findings of the ARRIVE trial: Labor induction versus expectant management in low-risk nulliparous women. (n.d.). value is what Coveo indexes and uses as the title in Search Results.–> ACOG. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2018/08/clinical-guidance-for-integration-of-the-findings-of-the-arrive-trial

Espada-Trespalacios, X. (2021, July 26). Induction of labour as compared with spontaneous labour in low-risk women: A multicenter study in Catalonia. PubMed.

Migliorelli, F. (2019, November 11). The ARRIVE Trial: Towards a universal recommendation of induction of labour at 39 weeks? PubMed.

ROSENSTEIN, M. (2013). The risk of stillbirth and infant death stratified by gestational age in women with gestational diabetes. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3403365/

Trends in labor induction in the United States, 1989 to 2020 : MCN: The American Journal of maternal/Child nursing. (n.d.). LWW. https://journals.lww.com/mcnjournal/citation/2022/07000/trends_in_labor_induction_in_the_united_states,.13.aspx

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