Even women who have wonderful, healthy and beautiful pregnancies are likely to be tired of being pregnant within a few weeks of their due dates. Feeling heavy, bloated, and tired, these mamas are ready to give birth. In today’s modern world, this situation can easily be remedied: just schedule an induction! In fact, many caregivers will induce their pregnant patients after the 39th week of pregnancy. One recent study found that 18 percent of labors in the United States are induced1, and with the challenges and perceived risks of going overdue, the question becomes, “why not?!” The answer is threefold:
1) Due dates are not accurate. A woman’s due date is based on the idea that she has a 28 day menstrual cycle, when many women’s cycles vary from as much as 24 to 36 days. Also, Caucasian women tend to have longer pregnancies than African-American women. To get a more accurate due date, add or subtract the number of days your cycle is different than 28. So, if your cycle is normally 32 days, then add 4 days to your due date, if it is 26 days, subtract 2 days from your due date. Then, if you are Caucasian, add a whole week to your new due date. This may dramatically change when you hit the 40 week mark, and when your care provider may consider inducing you. Also, remember that a baby may be ready for birth at 38 weeks, or he may not be ready until 42 weeks or beyond.
2) Elective induction is full of risks. The first consideration is that 40-50% of inductions fail2 and either result in the woman being sent home or ending up in the operating room for a cesarean section. In fact, 44% of those who are induced end up with a cesarean, as opposed to only 8% of those who start labor spontaneously3. The biggest concern about elective inductions is that they do not guarantee that the baby’s lungs are mature enough to breath on their own. Naturally, the baby will put off a protein once its body is ready, sending a signal to its mother’s body to start labor4. Inducing labor prior to this signal has resulted in an increase of premature babies who spend their first days in the NICU. A common reason that doctors give to schedule an induction is when the baby is perceived to be getting too large for a vaginal delivery. First of all, ultrasounds are known to be inaccurate at estimating weight, and second, ACOG recommends against induction for large babies because they almost double the cesarean rate without improving the health of the baby5. Every Baby Magazine says that elective induction for a first time mother should especially be evaluated because they often result in increased pain, increased intervention, and distress in the baby resulting in more instrumental deliveries6.
3) Post-maturity Syndrome is a false scare. Another reason why care providers and pregnant women elect to induce labor is when the pregnancy continues past 40 weeks. This is based on a 1958 study saying stillbirth dramatically increases after 40 weeks7. What we know now is that there is no rise in stillbirth from 40-42 weeks, and only a slight rise at 43 weeks8. After 43 weeks, less than 10% of babies will show signs of postmaturity syndrome; most by fetal distress, with a higher incidence of stillbirth. The risk becomes more likely as the weeks progress past 40, but do not begin on the due date. Large scale studies comparing delivery statistics from term (37-41 weeks) to post-term (past 42 weeks), found that the death rate of babies, meconium staining, shoulder dystocia, and cesarean sections occurred about the same in each group. The only difference was that post-term babies had lower rates of fetal distress, less instrumental deliveries, and higher apgar scores9.
According to professionals, legitimate reasons to induce include: high blood pressure, premature rupture of membranes, infection, diabetes, kidney or heart disease, suspected fetal jeopardy, fetal death, severe blood incompatibility, severe preeclampsia or toxemia, or a post date baby proven to be in danger10.
“Being pregnant requires one to let go of the idea that pregnancy, labor, birth, or parenting will ever be convenient”11. I remember being 40 weeks pregnant and wishing it was over. I even tried to induce myself, which didn’t work very well. In the end, I’ve come to realize that my time is better spent getting rest, getting pampered, and using it to grow patience useful for parenthood.
If your tempted to schedule an elective induction, talk to someone whose been in your shoes. Find some company, a hobby, go shopping, bake some food to freeze, or get some rest. Your baby and your body will thank you for your patience.
Resources:
1. “Induction Junction” by Pamela Richardson. Pregnancy Magazine. November 2005
2, 10. “Let the Baby Decide” by: Nancy Griffen. Mothering Magazine. March 2001
3. www.cnn.com/2007/HEALTH/08/23/ep.csection/#cnnSTCOther1
4. “You Can Wait” by Debbie Amis. Lamaze Parents Magazine 2006
5. Lamaze Institute for Normal Birth. Care Practice #1: Labor Begins On It’s Own
6. “Come On, Baby” by Naomi Freundlich. Every Baby Magazine. 2006 Issue 4
7,8,9. “A Timely Birth” by Gail Hart. Midwifery Today Issue 72
11. “Priorities in Birth” by Jennifer Rosenberg. Midwifery Today. Winter 2002
