Induction

Induction is something that has really been on my mind lately.  I hear of more and more women getting induced because they’re “sick of being pregnant.”  Oh, I’m sorry…what did you think you were signing up for when you got pregnant?  Another common reason is that they’re “overdue.”  Well, there are a few things wrong with that. 

1. Humans have the most variable gestation length of all mammals.  No one can predict when your baby will be ready to arrive.

2.  Every baby, woman and pregnancy is different.  Yes, pregnancy is an average of 40 weeks, but did you know that first time pregnancies are more around 41 weeks?  Yet so many providers are anxious to get those babies out by 41 weeks!  The ACOG (American College of Obstetrics and Gynecology) actually recommends labor induction at 42 weeks, NOT 41 weeks unless medically necessary.  It’s true that the longer the pregnancy the greater the risk for postmaturity syndrome.  The placenta can become “old” and calcify, which presents health risks for the baby, amniotic fluid can decrease, and the baby can stop growing or lose weight.  But if the mom is watched closely and everything is made sure that everyone is healthy, there’s no reason to just let nature take its course.  A normal, full-term pregnancy is considered anywhere from 37-42 weeks…which, of course, is all relative, as well.  But actually, post 42 weeks is usually safe, as the ACOG has stated that 95% of babies born between 42 and 44 weeks are born safely.    

3.  Due dates are estimates.  No one can know exactly when a baby will arrive.  We do our best based off of last menstrual period, but even that is inaccurate because not every women has the textbook 28 day cycle with ovulation on day 14.  Sometimes the due date is calculated with an early ultrasound, but it all boils down to when both mom and baby are ready.  Pregnancy length is also dependent upon ethnicity, number of previous pregnancies, your age, weight, and (but not limited to) prenatal nutrition.  I’ve actually read a few places that the current way that due dates are calculated (Naegele’s Rule) is not the most accurate because most women do not have the textbook 28 day cycle with ovulation on day 14.  Mittendorf’s Rule takes into account different cycle lengths.  You can check that all out here: http://www.transitiontoparenthood.com/ttp/parented/pregnancy/duedate.htm

4.  There are a few theories on what actually triggers labor.  For a while, it was believed that the mother’s body is the one that starts labor, but now researchers believe that it’s actually the baby who is responsible for triggering labor.  One is that the baby’s lungs secrete a chemical when they’re fully developed.  This chemical causes prostaglandins to be released into the mother’s system, which trigger cervical changes and contractions.  Another theory is that, when the baby is ready to be born, its adrenal glands send out hormones to the mother’s body, signaling labor to start.  Just think – if a woman is induced before the baby’s lungs or other important body functions aren’t quite ready, that baby could have problems for their entire life.

If you are faced with the threat of induction, ask your provider what your alternatives are.  You always have the right to ask – they can’t make you do anything you don’t want to do.  You can do NSTs (Non-Stress Tests) and amniotic fluid tests to make sure that baby is healthy.  And as long as mom and baby are healthy, there is little risk of waiting until baby is ready, as Pitocin brings on problems of its own (I’ll address that in another post).

Also, don’t let your provider scare you into thinking you have a big baby.  Cephalopelvic disproportion (CPD - when the baby’s head is too big for the mother’s pelvis, which makes a vaginal birth impossible) is very rare (about 1 in 250, and even if you are diagnosed with CPD, that doesn’t mean you’ll have it again in subsequent pregnancies), yet doctors tend to diagnose many many women with this based on an inaccurate ultrasound calculation.  The only way to truly diagnose CPD is when the mother is actually in labor.  And even if they don’t threaten with CPD, you might be scared that your baby will be really big and you’ll tear or not be able to birth a “big” baby.  First off, if you listen to your body, have good coaching from your provider, let them stretch you and allow yourself to stretch, your tearing will most likely be minimal to possibly nothing!  Second, bodies are amazing things, and even if your baby IS bigger than the average newborn, you’ll be amazed at what your body can do.

My experience: I have known my exact ovulation date with every one of my (three) babies and my pregnancies were all past my “due date,” each going longer than the last!  My third baby was born at 41w5d after a LOT of encouragement.  I was confident that the baby would come when she was ready, but anxious because the 42 week mark was quickly approaching.  When she was born, she was only 7 lbs 8 oz and neither she nor the placenta had signs of “old age.”  If I would have given in to the thinking that my baby was in danger once I hit 40 or 41 weeks, think how small she could’ve been.  She just wasn’t ready.

Moral of the story:  Just let your body do what you know it can do.  Having this deadline of when the baby is “supposed” to arrive makes a woman and everyone close to her very anxious and stressed out as that date draws nearer.  When a mom can relax, it can help her go into labor – being tense just prolongs it.  Instead of having a due date, have a due window.  So say you are due February 17.  Your due window would be 3 weeks before and 2 weeks after, being Jan 27-Mar 3.  It helps to lessen the deadline part of pregnancy.