Inductions part 2
5 Good reasons for an Induction
1. Pre-eclampsia/Toxemia – This can be a serious risk to mom and baby. You just want to be sure it is really pre-eclampsia and not just a few elevated blood pressure read. There are many different things a care provider will look at. Before agreeing to an induction you would want to do a 24 hour urine collection and a liver panel, to confirm the diagnosis. The link explains more. Many times with elevated blood pressure they will put mom on bedrest and monitor her closely. Many will not tell mom that if she ups her diet in protein and adds more calcium and magnesium, that can help with her blood pressure as well.
2. IUGR – Baby is not growing as quickly as expected.
3. Low Fluid – This certainly can be a legitimate reason if the fluid level is below 5. Sadly I have seen 3 moms in the last 6 months told your fluid is low go to the hospital right now. Their levels were all below 10 but above 5. While it is something to watch, if baby is doing well (typically they measure fluid in conjunction with a NST) another more expectant management approach is to send mom home to drink 2 liters of water and come back later and have the fluid re-measured. It very well may have gone up! If not then an induction is still an option. But again, if it is above 5 it may not be urgent if baby is doing well. Maybe to help circumvent this, if you are going in for NST drink a LOT!!!
4. PROM – If moms water breaks before her birthing time starts most care providers are anxious to have the baby out within 24 -48 hours. It is pretty standard for them to want to start an induction within 12 hours of moms water breaking. If mom and baby are not showing signs of infection it may not be necessary. (click here and scroll down to #4)
5. Postdate (42 weeks pregnant) – The risks to mom and baby increase after 42 weeks gestation (more so in high-risk moms). So you may choose to get induced at this point. But it is still your choice.
5 Questionable Reasons for Induction
1. 40-42 weeks
Increasingly I am seeing moms feeling pressured into inductions at 41 weeks or even 40 weeks. Why is this? Statistically there are not BETTER outcomes for moms who induce at this time. Some OBs will cite a study that says the risks of induction don’t increase if done at 41 weeks, but when the study was reanalyzed, they found that not to be true.
If you are a mom who is wanting a natural childbirth, it is much easier for you and the baby if you wait for your birthing time to start on its’ own. If you feel good about waiting, your intuition says all is well with baby and if your care provider says all is ok with you and baby then you can say no to the induction! Wait until your body and baby are ready! Statistically first time moms don’t even start their birthing time on their own until after 41 weeks! Most care providers will want you to do kick counts and Non Stress Tests to reassure them all is well.
2. Big Baby – This one is really common today. Even ACOG says it isn’t a good idea to induce for this reason unless they think the baby will be over 11 pounds.
3. “low” fluid and PROM – These are listed above as good reasons. I think they usually are, but you should ask a lot of questions and trust your intuition.
4. Mom tired of being pregnant – Babies need to grow until they are ready to be born. This leaves a 5 week window of normal 37-42 weeks, so be willing and ready to go the distance! Some moms who are uncomfortable at the end of their pregnancy are just grateful to have a date when the baby WILL be here, they may not be informed of the risks that inductions are to them and their baby. Again, make sure you know your Bishop’s Score. Waiting another few weeks is a lot less risky and comfortable than ending up with a cesarean.
5. OB heading out of town/ Big Football Game/ Convenience
5 NO risk alternatives to inductions
1. Hire a care provider who trusts birth! They are less likely to suggest an induction, unless it is truly medically necessary.
3. Hypnosis – Hypnobabies has a Baby Come Out CD
4. Sex – (As long as your water hasn’t broken). The old adage, what got you into this can get you out of it. Enjoying it is one aspect (not always easy at 40+weeks) but also the semen has prostaglandins that can help soften the cervix. Try laying there with your bum on a pillow for 20 minutes. (Didn’t work for me, but it can’t hurt, it could even be fun.)
5 more good links about inductions
What Doctors can learn from Midwives regarding inductions.
Citizens for Midwifery – some good links regarding inductions.
Christian perspective on trusting God and birth and inductions.
5 Ways to Avoid a Cesarean – Induce when medically necessary is number 1.
L&D Nurse point of view on slew of inductions.