Medical & Non-Medical Reasons for Induction
Inducing labor is the artificial start of the birth process through medical interventions or other techniques. The rate of inductions in the United States has more than doubled since 1990,[1] and the overall rate in 2017 was 25.7%.[2]
What can possibly explain the substantial increase of inductions? For one, many obstetricians favor inductions because they’re convenient and generate more revenue. Additionally, obstetricians (as a whole) are trained surgeons who have generally been taught that birth is a medical event that needs to be managed. Some have a deep mistrust of the natural process, which leads to a belief that aggressive medical management will result in better outcomes.
This isn’t to say that inductions don’t serve a purpose though. Today, we’ll explore common medical and non-medical reasons for inductions, disadvantages to consider, and alternatives worth trying.
Medically-Indicated Reasons for Induction
The benefits for medically-indicated inductions outweigh the risks. Medical reasons a provider may have for suggesting an induction include:
Post-term pregnancy. A pregnancy that has gone 42 weeks or longer.
Bag of waters has broken, but birth process hasn’t started spontaneously. This is called Premature Rupture of Membranes (PROM) and the risk of infection for you and your baby is slightly increased.
Medical conditions. These can include preeclampsia, high blood pressure, and diabetes.
Baby isn’t thriving in the uterus. For example, the baby isn’t getting enough nutrients and oxygen from the placenta.
Things to Consider:
American Congress of Obstetricians and Gynecologists (ACOG) defines a post-term pregnancy as 42 weeks or later. Medical providers have differing opinions on what's considered a prolonged pregnancy, so it’s important to confirm if there’s a valid medical reason for induction. Some caregivers offer inductions between 39 to 41 weeks, but without a medical reason, the risks of induction before 42 weeks outweigh the benefits. However, waiting past 42 or 43 weeks increases the chance of stillbirth. “In 2019, ACOG reaffirmed their 2014 recommendations on post-term pregnancy. Although their guidelines are not freely available to the public, ACOG recommends that induction of labor should take place between 42 weeks 0 days and 42 weeks 6 days, and that induction at 41 weeks can also be considered.” -EvidenceBasedBirth.com
The overall risk of infection for your baby after PROM is about 2% if you wait for the birth process to begin on its own, and 1% if you’re induced immediately. If you’ve tested negative for Group B Streptococcus (GBS), then your risk for infection is 1.2% after PROM.[1] Induction after PROM reduces the risk of infection, but not cesarean section. The American College of Nurse Midwives (ACNM) advise that women should be informed on the risks and benefits of induction after PROM, and if they meet certain conditions, they should be allowed to wait for labor to start spontaneously. Learn more about their position statement on Premature Rupture of Membranes at Term.
Inductions are typically paired with additional interventions, such as continuous electronic fetal monitoring and IV fluids.
Elective Reasons for Induction
Elective inductions are performed for non-medical reasons. Some reasons you or your care provider may have for scheduling an elective induction:
Convenience for you or your medical provider. An induction may be scheduled when your preferred doctor is on-call or when you have household help. Keep in mind that hospitals routinely schedule inductions Monday through Friday, and there’s usually a spike before big holidays like Thanksgiving, Christmas, and New Year’s. During the pandemic, you and your birth partner can be tested for COVID-19 and cleared for pre-admittance.
Routine procedure. Many caregivers will suggest induction at 39 or 40 weeks without worrying about the potential risks of prematurity or c-section. In some states, midwives can’t legally attend home births after 42 weeks, so membrane stripping (also called membrane sweeping) may be offered to avoid more aggressive forms of induction.
Suspected macrosomia. This is the medical term for a big baby. Some researchers consider a baby to be big if they weigh 8 lbs 13 oz or more at birth, while others believe babies are big if they weigh 9 lbs 15 oz or more.
Shorten pregnancy due to discomfort.
Living far away from the hospital.
History of rapid births.
Limitations of rooms/bed in labor & delivery unit.
Things to Consider/Disadvantages:
Some inductions can proceed slowly (24-48 hours), which can be very exhausting and discouraging. Induction procedures can be paused to allow more time for the birth process to progress and avoid a c-section. However, some caregivers may decide on a c-section after 12 hours.
It’s impossible to accurately predict a baby’s size before it’s born. Research has shown that physical exams and ultrasounds provide unreliable results.[3] Induction for a suspected big baby increases the risk of cesarean sections and doesn’t improve health outcomes for the mother and baby. In terms of induction to avoid shoulder dystocia, a condition where a baby’s shoulders get stuck after the head is out, most of these cases happen in average-sized babies and caregivers can resolve it without harmful consequences for the baby. If you’d like to learn more, check out EBB’s Evidence on: Induction or Cesarean for a Big Baby.
Babies can benefit from having additional time in the womb to mature. Normally, babies who are fully developed will send out hormones letting our bodies know that they’re ready to be born. Rushing the process before a baby is ready can result in prematurity.
When labor starts on its own, your body produces natural oxytocin to orchestrate a quicker, more efficient, and comfortable birth. Synthetic oxytocin (Pitocin) reduces the natural release of oxytocin and is unable to cross the blood-brain barrier to produce pain-relieving effects. Women who receive Pitocin generally experience stronger and more frequent pressure waves (contractions), and thus, request pain medications or epidurals.
As previously mentioned with medically-indicated inductions, more interventions may be needed with elective inductions, such as continuous electronic fetal monitoring, IV fluids, epidural, and c-section.
Prostaglandins used to soften the cervix may cause nausea, vomiting, fever, intense/more frequent pressure waves, and fetal distress.
Alternatives:
Wait for the birth process to start on its own. Trust that the childbirth experience will unfold as it is meant to.
Try non-medical methods to jumpstart the birth process. These include nipple stimulation, sexual intercourse, acupuncture, evening primrose oil, and blue/black cohosh tea. Consult with your provider before trying these natural options.
The Takeaway
For low-risk pregnancies, birth is a physiological process that works best when left undisrupted. It involves a complex set of hormonal interactions that divinely prepare your baby for life outside the womb, facilitate the birth process, help you and baby cope with stress, promote successful breastfeeding, and foster bonding between you two. Of course, if you do require an intervention and increased level of medical care, this does not minimize your worth or experience. There is no shame for honoring what your body and baby need.
The drugs and procedures used for induction come with risks, so it’s important to consider the advantages and disadvantages if there’s no medical reason for intervention. I hope this article helps you make an informed decision that feels right for you and your unique pregnancy.