Most pregnant women get to 37 weeks gestation and sigh a breath of relief because childbirth is imminent. They’ve made it past the preterm stage. Then the waiting begins. And the incessant questions: Have you had that baby yet? When are you being induced?
Induction of labor seems to be so common these days. Nearly every other woman you know had to have some help getting her labor started. In fact, in the U.S., induction has more than tripled since it first began to be recorded from certificates of live birth in 1989. Then it was nine percent of births. In 2020 it was up to 31.37 percent, according to the National Center for Health Statistics (NCHS). The last few years have seen even more increase. But world organizations (including the World Health Organization) agree that induction of labor should only occur when it’s medically indicated.
Do you want to be induced even if you’re not high-risk? You need to be informed to participate in the discussion. Here are eight considerations to help you make an informed decision about whether to induce or not.
What to Consider …
You’re Ready
You’re so very ready to have this baby! It’s been a long pregnancy and you’ve had enough of the big belly, the never-empty bladder and not being able to see your feet. You’re over the lack of sleep, the Braxton Hicks and the never ending questions about when you’re due. But wait a second. Just because you’re ready, it doesn’t mean Baby is. That estimated due date might’ve arrived, but it doesn’t mean labor is imminent. Estimated due dates are exactly as advertised — a guess at the time your baby will arrive. Only three to five percent of babies actually do arrive on that date so it’s clearly just a “guesstimate.”
Many care providers are still focused on pregnancies going past the 40-week estimated due date. That’s why inductions tend to be booked once a woman reaches 41 weeks, as a ‘just in case’. According to the National Institutes of Health, one in 10– 12 childbirths are induced for elective reasons. Yet inducing labor runs the very real risk that your baby will be born before they are ready. In the last weeks of pregnancy, your baby’s lungs are maturing. Fat needs to be deposited, also. So just because an ‘average’ length of time has been established for pregnancy doesn’t mean every baby will be ready within that time frame.
Baby May Be Big
You may be so big you look like you’re having twins, but your ultrasound confirms you’re having just one. You’re jumbo, but baby may not be. More than 30 different algorithms are used to predict a baby’s weight via ultrasound. And while ultrasound weight estimates are more accurate than they used to be, there is still a 15 percent margin for error in weight estimation. (That means your baby can be either 15 percent smaller or 15 percent larger than the estimated weight given at your ultrasound.)
Next, the closer you are to your due date, the harder it is to estimate your baby’s size. Many women are induced for a suspected big baby (macrosomia), and then discover their baby is actually average-sized, after interrupting a perfectly healthy pregnancy. One-in-three women in the United States report being told their babies are too big, according to the NCHS. Suspected macrosomia isn’t a medical indication for induction or c-section, but it is one of the most common reasons given for either of these procedures.
Your Care Provider Might Not Be Available
Uh-oh. Your obstetrician reminds you that she will be on leave around your due date. You can hope you go into labor beforehand, or you can just schedule an induction. Sounds easy. But again, it’s not that simple. Your baby may not be ready to be born. Your body might not be receptive to induction and fail to get the hint. This often leads to what is known as ‘failure to progress’, which sounds a lot like it’s your body’s fault. Ask to meet your doctor’s back-up provider so you can feel more at ease if they end up delivering your baby.
It’s Convenient
Your parents are flying in from out of state the week before you’re due. Your husband is working at least an hour away from the hospital and your babysitter has exams when you need her to be with the kids during your hospital stay. Wouldn’t it just be easier to induce and know exactly the day your baby will be born, so it’s more convenient for everyone else? Well, yes. But if your baby and your body aren’t ready for labor, an induction is more likely to fail than succeed. Once an induction has been started, there’s no going back — even if that means having an unplanned c-section for failure to progress.
You’re in False Labor
False labor is difficult. You’re anxious, impatient, bored and tired — and experiencing Braxton Hicks contractions. This is the time when you may just go for the induction. Induction has many risks and it’s important to weigh those up when considering getting things moving along faster. Your baby won’t be in there forever.
Hospital Policy
Hospital policy on induction of labor varies. In one hospital it might be at 10 days post due date; in another might be as soon as you reach 39 weeks. Depending on your doctor, you might be booked for an induction because active management is perceived as a way of preventing things going wrong. But hospital policy is not law. Many women aren’t aware they can decline an induction if there is no medical reason. You can ask your care provider to check your baby’s health, and yours, until your labor begins spontaneously.
It’s Complicated
There are risks to induction, as there are with all medical procedures. It’s important to balance those risks against the chance that you might develop a complication.
If you are having a healthy pregnancy and your baby is healthy, it’s not likely you will develop a complication. It can happen, but that doesn’t mean it will. It may make no sense to interrupt a healthy pregnancy and force a healthy developing baby out just in case you develop a health condition, which in most cases is very unlikely to happen.
If you prefer a spontaneous labor and you are not high-risk, then ask for one. That’s all you have to do. In the last weeks of pregnancy, maternal antibodies are passed to the baby that help to fight infections, so really, every day that Baby is safe in the womb counts.