Thirty-nine weeks into her second pregnancy, Queen Anne mom Karri Lapin elected to have her labor induced for convenience’s sake. Her mother was in town and available to stay with her older child, a great benefit for everyone. Because she was so near to term with a “favorable cervix” — a cervix that has begun to thin and dilate in preparation for labor — her doctor advised that she was a candidate for elective induction.
If labor is imminent, why choose to have it stimulated with medication? Usually, the answer is convenience and control. “It was just so easy!” says Mercer Island mom Monica (not her real name) of her elective induction. Monica’s first birth experience was difficult; she felt out of control and frustrated. She was sent home from the hospital in early labor because of insufficient space and nursing staff. Her own doctor was unavailable. She endured a poorly administered epidural and resulting spinal headache.
So for her second delivery, Monica was anxious to avoid a repeat of those traumatic experiences. “I wanted a better shot at controlling the environment,” she says. Monica chose induction to ensure that a bed, her doctor and the anesthesiologist of her choice would be available. She got exactly what she wanted with her induction, and felt very happy about the experience.
Lapin was pleased with her induction, too. “It was a very controlled birth from the beginning,” she says. “Overall, it was a very good experience.”
What are the risks?
There are risks that women should know about when considering an elective induction. “With women in first pregnancies who labor spontaneously with intent to deliver vaginally, the chance of a cesarean section is about 15 percent to 17 percent. With elective induction, the risk is three times that,” says Dr. David A. Luthy, medical director of the department of OB/GYN at Swedish Medical Center in Seattle. This fact concerned Luthy and his colleagues, whose research turned up data that suggests that induced births also mean longer hospital stays and more nursing hours. As a result, Swedish has implemented guidelines barring elective inductions before 39 weeks and limiting them to women with a favorable cervix, ideally in a second or subsequent pregnancy. The goal is to limit elective inductions for first babies. Under this new policy, the elective induction rate at Swedish went from 25 percent to less than 1 percent for first-time mothers.
With a cesarean rate exceeding 31 percent in our country, it seems like everyone is doing it. Why try to avoid it? Research consistently shows a higher rate of mortality in mothers who have C-sections. In addition, babies born by cesarean have elevated risk of respiratory problems and long-term lung issues, and women who have cesareans have more problems breastfeeding, which also increases health risks for their babies. While there is no doubt that cesarean section is a life-saving surgical tool, it carries with it risks that uncomplicated vaginal birth does not.
Elective induction of labor carries other risks as well. Some of the medications used for induction have been associated with uterine rupture as well as significant reductions in breastfeeding rates. Other risks of induction include unfavorable changes in fetal heart rate, increased risk of infection and overstimulation of the uterus.
Elective induction before 39 weeks is associated with a significant increased risk of prematurity-related health problems in the newborn, according to the March of Dimes. Even late-preterm infants can experience a host of complications after birth, ranging from difficulties with feeding to hypoglycemia, temperature instability and respiratory distress. Late-preterm infants have higher rates of developmental handicaps that stick with them into grade school and beyond. In the United States, preterm birth accounts for more than two-thirds of infant mortality and half of long-term neurologic morbidity (brain damage and brain death).
Because of this, it is critical that the dating of a pregnancy be accurate in order for these risks to reduce at 39 weeks. The problem is that estimating gestational age is inexact. If a woman does not have a precise date for conception, there is some guesswork involved.
Some women find ways other than induction to gain control over their childbirth experience. Like Monica, Renton mom Melissa Kruger had a difficult first birth in which she felt out of control. For her second baby, she chose a home birth with a licensed midwife. “I needed to be completely alone during most of my labor,” says Kruger, who describes the birth as an empowering experience.
Still others abandon control and surrender to nature. “Most of us in this country are used to some degree of control over our physical sensations,” says Robbie Davis-Floyd, Ph.D., a medical anthropologist specializing in the anthropology of reproduction. When Davis-Floyd gave birth, she says, she “found it valuable to fully experience a physical reality without such control.
“My self-esteem and my sense of personal courage and power grew enormously as a result of my experience of labor and birth,” she says. It goes without saying that there is more than one way to frame a positive birth experience. Knowing the risks and benefits of available choices can help women determine their own best route.
Former executive director of Great Starts Birth & Family Education, Tera Schreiber is a freelance writer who frequently writes about women’s health and parenting.