Obstetric Lie #82- Induction Is Risk Free

Of all the things going on in obstetrics today, I truly believe that the induction epidemic is the biggest issue, the ugliest problem, and the subject that we most need to talk about with women.  In fact, it is my opinion that if we were to simply LOWER THE INDUCTION RATE we would drastically decrease the cesarean section rate.  

Of course, I don't expect you to just listen to me.  

Let's talk turkey.  

There are a hundred reasons why a woman would be induced for labor and many of them are certainly legitimate.  My concern (and the concern of many who are paying attention and value the lives of women and the unborn) is that inductions are being done far too often and are in fact negatively impacting birth and creating problems that wouldn't have existed otherwise.  

Let's start with some information from the Mayo Clinic.  They are legit and medical and all the things that I am not.  But the folks over at the Mayo Clinic recognize that induction is not without risk and should be considered carefully and thoughtfully.  

Some risks that the Mayo Clinic lists regarding labor induction are:

~Increased c-section rates

~Increased risk of premature birth

~Low heart rate (in baby and caused by induction drugs like Pitocin)

~Infection (in both mother and baby)

~Umbilical cord problems (prolapse, when the cord falls down into the vagina ahead of the baby and is life threatening for baby)

~Uterine rupture (unnatural contractions brought on by drugs can literally break your uterus)

~Postpartum hemorrhage (again caused by induction drugs, the uterus sometimes won't contract on it's own after an induction)

As you can see there are many risks to both the mother and the baby when we induce.  I think there are a few questions we need to ask ourselves and our care providers before we consent to induction.  (Despite the flawed system and the huge push for induction, it is probably time we admit the hard truth that an induction is still something that a woman CONSENTS to and can therefore NOT consent to.)

Some questions we may want to ask before consenting to induction:

~Why am I being induced?  Have I researched this reason?  

Your care provider is an expert.  They went to school for a long time.  It would be wonderful if I could say that across the board women can trust that their care provider's opinion is in the best interest of them AND their baby.  I wish I could say that.  

I can't.

Question everything.  Research (and I mean REALLY research).  Read articles.  Study.  Get a second opinion from somebody in a different practice.  It boggles my mind that we get a second opinion when it comes to our gallbladder but totally skip this when it comes to our own BABY.

You may or may not come to the conclusion that induction is right for you.  That is great.  But you should come to that conclusion fully facing the TRUTH of the risks on both sides.  When we become mother's we need to start making hard choices and stop blindly leaping into things because everybody else is doing it.  

~Do the risks of staying pregnant OUTWEIGH the risks of induction? 

Let's be real.  The end of pregnancy is kind of crappy.  A hundred years ago women just had to wait for mother nature to kick in before they could get rid of the swelling and the sore hips and the gas and the other unpleasantness.  

Not today.  I know a lot of care providers probably push unnecessary inductions.  But I have gone a week and a half overdue and I know for a fact that putting that frosted brownie (induction) in front of a woman on a diet (end of pregnancy) is pretty stinking tempting.  

There is no shame in admitting that we sometimes want to be induced.  But it is sad to be induced because you are uncomfortable and then have one of those very negative things listed above happen when it didn't need to happen.

So- do the risks of staying pregnant really outweigh the risks of induction?  Or are we getting induced because we are miserable, our doc is going out of town, we don't want to have the baby on the weekend, or we hit the magical 40 week mark? 

~Is my care provider being honest with me about the risks of induction?

I realize that I am going on and on about the risk of induction.  It is a fact that induction can increase risks.  BUT- hospitals and doctors are pretty amazing.  You most likely will not die from your induction.  You could die from an induction- (and your baby could too)- but you probably won't.  Even if things go a little nuts they can probably be fixed with a drug or a surgery and both mom and baby will survive and even be healthy within a few weeks. 

So, even with an induction all will probably be fine.  But is your care provider aware and open and HONEST about the above listed risks of induction?  Sometimes it seems to me that the risks of induction are often waved away with a flick of the wrist and a date is scheduled (or threatened).  

If your provider induces everybody, has a high c-section rate (over 15%), manages to work obstetrics like it is a nine-to-five job, then you might want to pause and consider what is going on.  Are you being induced because it is needed or because it is convenient?  Is a reason for your induction being manufactured or is it legitimate?

Food for thought.

Do I realize what an induction entails?

Education about birth and what happens in our bodies AND what happens during typical procedures is imperative to making a truly informed birth choice.  I like this post from Midwife Thinking on what really happens when we consent to induction. 

I don't know how many times I have talked to women and they state that they had no idea that when X happened so would Y and Z.  

An induction usually involves an IV of Pitocin.  It usually involves constant monitoring of mother and baby by an EFM.  Those two things combined make it pretty hard to walk around or move or otherwise encourage contractions in a normal, natural, way.  Many women also get an epidural after the induction begins.  This usually means a urinary catheter is inserted too. 

I just want you to take a moment and count how many tubes will be coming out of your body at this point.  Now think about how that will impact your birth.

And if you are a first time mom, you deserve to know also that your are doubling your chance of c-section.  Doubling.  

If you truly want to avoid a c-section your first step is most likely avoiding an induction.  

Do I realize the risks of induction on my baby?

I assume that all mother's are truly concerned about their little one's well being more than their own.  When I teach natural birth classes women are often motivated to "go natural" because they want the best start for their baby.  The same thing (a healthy baby) is often also a motivator for an induction. 

So, let's assume that you are getting induced just a week or so early.  Or maybe you are getting induced on your due date but your date's are a little off.  Or maybe you are getting induced on your due date but you have one of those babies who needs to be gestating for 42 weeks.  (An easy way to see when your baby is ready to be born is to just wait for them to trigger labor.)

Are their risks to getting that baby out a week or two early?  

The answer is a resounding YES.  

This study mentions some of the problems associated with a "near term" infant.  This is a baby that is almost ready to be born, will survive, but may have a few more bumps in the road than it needed to have.  (You deserve to know too that a slightly early baby may have some initial trouble nursing and that too can impact lifetime health.)  Another study found that respiratory distress syndrome increased the earlier a baby was born via elective c-section.  (I know we aren't talking about elective c-sections here, but I think this applies just a little.)

I want you to know that I realize that sometimes inductions ARE necessary for the health of mom or baby or both.   (I always get angry comments from people who needed their induction.  I am not actually picking on you.)  But the rates we are seeing for inductions (and augmentation of labor) is frankly ridiculous and is the very first problem we should address when we start talking about the equally outrageous c-section rate. 

Know your options.  Know the risks.  Know the benefits.  THEN make your choice.  That is all we can do.