What you should know about induction if the baby is late

If your doctor suggests inducing you, you may not be sure what’s involved or if it’s really necessary.

The number of women who have labor induced has skyrocketed. Some women are tired of being pregnant and an increasing number are being encouraged by their physicians to have labor induced. Threats of “your baby is getting too big” or “your blood pressure is a bit high” or “going past your due date is dangerous” and seduction with “your baby is ready, let’s get on with it” are almost routine.

It should, however, be noted that the induction of labor is not a straightforward predictable science. A large number fails and leads to unnecessary cesarean deliveries. Truth is, the management of pregnancy at and beyond term has been a topic of debate worldwide within the medical and midwifery community for many decades. 

The controversial discussion concerns the pros and cons of induction of labor in light of medicalization of the ‘natural’ birth, the difficulties to identify the appropriate length of human gestation and the definition of whether or not a pregnancy is ‘overdue’, ‘post-date’ or ‘prolonged’.   

Here’s what you should know:

Many babies are born about a week late - especially first babies. But if one week stretches to two and you’re still waiting, you may hear the word “induction” mentioned-which means your labor will be started artificially.

On average, 17 percent of labors are induced, though this varies widely depending on hospitals and doctors.

Why induce?

You might need to be induced if:

• Your waters have broken but contractions fail to start
• Your baby is overdue
• You have very high blood pressure or pre-eclampsia
• You start bleeding in late pregnancy, due to partial separation of the placenta
• You have diabetes
• You and your baby have rhesus incompatibility.

Does it matter if the baby is late?

After a certain time, your placenta works less efficiently and can’t provide your baby with all the oxygen she needs - so your baby should be delivered before this happens.

Some obstetricians like to induce women who are just one week late, while others may wait for two weeks or longer. This is because, for most women, there’s a period during which it is safe to either induce the baby or wait for natural labor.

It’s thought that the placenta in older expectant mums starts to fail sooner - so if you are aged 35 or older, you may find that your doctor suggests an induction earlier than she would for younger women.

Pluses and Minuses

In some cases, induction is vital for your baby’s health - but it has other benefits too. For a start, you will save yourself a few days of discomfort, and your baby is likely to be smaller, making delivery easier. You also won’t have to worry about going into labor unexpectedly so you can let your partner know when to take time off work and arrange for someone to look after your other children. On the minus side, inductions are always performed in the hospital, so you won’t be able to spend the early part of your labor at home and you may pass a sleepless night on the ward waiting for it to take effect.

In most natural labors there’s a slow build-up when you’re pottering around at home not really sure if you’ve started or not. When you’re induced, particularly with oxygen, contractions can be quite intense from the start, making the labor less easy to cope with. And being attached to a drip and monitor means you can’t move around freely, so you’re likely to be sitting in a hospital bed anticipating each contraction, which may make them seem worse.

Women who are induced are also more likely to need pethidine, an epidural, forceps delivery or a cesarean section - and the induction is not guaranteed to work!

There are various ways to induce labor, and they may be used separately, together or one after the other, depending on your circumstances.

Induction and your baby

With an oxytocin drip, the frequent, strong contractions can reduce the blood supply to the baby, so there’s an increased risk of hypoxia (lack of oxygen).

Your baby’s heart rate will be monitored carefully and if she’s showing signs of distress, the drip can be turned off or a cesarean carried out, depending on your circumstances.

Babies who are induced may also take longer to start breathing.

Staying in control

Make sure you’re involved in all decisions to do with your induction. The key to staying in control is knowing what’s going on, so ask questions every step of the way. For instance, you might like to ask:

• What would happen if you waited a bit longer
• What kind of procedure would be used
• What’s likely to happen
• What would happen if it wasn’t effective
• Is there any other way of inducing labor
• What kind of monitoring would be used

Is induction absolutely necessary?

Although the due date might seem to have magical qualities, it is simply an educated guess about when the baby is most likely to arrive. It is perfectly normal to give birth one to two weeks before or after the due date. 

Relevant literature shows a diversity of opinions on how and to which extent pregnant women should be informed of conflicting evidence on treatment options they would have to decide on. I advocate and promote nature’s plan and normal birth. Nature is not perfect. However, when it comes to babies and birth unless there is a clear medical indication that induction of labor will do more good than harm, nature beats science hands down. 

For both mothers and babies, it is safe and wise to wait patiently until labor begins on its own.

Don’t be rushed into a decision - tell your doctor you’d like to think it over and discuss it with your partner before you decide.

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