• Kim Hood, MD

Labor Induction or No?

Updated: Dec 2, 2019

Alright my little Ladybugs, let's talk about labor induction. So many women are terrified to be induced. I have seen really sick women not show up for inductions and risk losing their baby's or their own life just to avoid the perceived risk of labor induction. Many OB's that work in a group that covers well for each other also do not push labor induction. We simply find it more inconvenient to do because labor inductions of women can take so much longer to do than if the patient comes in laboring. However, is there really an increased risk of harm to the baby or is there really an increased chance for cesarean if you have in induction after 39 weeks gestation but before 40 weeks of gestation? Well, there are some studies that say no.

The one I will make reference to in this post is from The New England Journal of Medicine. This was published August of 2018. It was a multicenter, randomized, control trial; the gold standard in research. It took place in 41 different hospitals and involved over 6000 women. About 3000 were induced between 39 0/7 weeks to 39 4/7 weeks gestation and the other 3000 were allowed to go into labor on their own. None of these women had children already, and they were all normal, healthy pregnancies.

What they found is what I have long known from anecdotal experience. First time moms, who are induced have longer labors. However, they found that there was not an increase in harm to the baby when compared to the women who were expectantly managed; ie., allowed to go into labor on their own, and may even be associated with a 36% decrease in adverse perinatal outcomes; ie., harm to the baby. They also found that induction between 39 - 39 4/7 weeks resulted in a decrease risk of cesarean section and hypertensive disorders when compared to the women who were allowed to wait. The data also showed that 1 cesarean section could be avoided for every 28 deliveries of low risk, nulliparous (never had a baby before) women who underwent elective induction at 39 weeks. The data did not even change if the woman's cervix was unfavorable (not dilated or effaced or soft).

Why is this possible? This was not addressed in the study. However, in my humble opinion, there are a few reasons. To me, if there is a problem called preterm labor, then should not the opposite exist? Is it not possible that babies can stay in too long? People often say, "The baby will come when the baby comes!" Nope! What if we said that when the baby is trying to come at 28 weeks? That would be scandalous!!! We do everything we can to try to stop that baby from coming too early. I believe intervention is needed when the baby is trying to come too late.

When the baby goes past it's due date, there is very little if anything to gain. The baby continues to get bigger, and the placenta continues to get older. The baby gains a 1/2 pound per week after 36 weeks. Big babies do not fit through the pelvis well, and a 1/2 pound can make a big difference!

The placenta is made of bunches of very tiny blood vessels. It is responsible for getting fluids, nutrients, and oxygen to the baby. One thing that occurs after the due date, is the placenta gets older and may not function optimally. We sometimes see low fluid around the baby. Amniotic fluid is baby urine. If the baby is not urinating late in pregnancy when it did earlier in pregnancy, it's likely because it is not getting adequate fluid. Then during contractions, the placenta gets "squished." The blood and oxygen cannot get through old blood vessels, and the baby shows signs on the fetal monitor that it cannot tolerate labor. Mom gets a cesarean.

Now, this study did have some limitations. They all do. However, this is a very good study. I'm sure there will be others in the future to try to reproduce these outcomes. They'll probably compare community hospitals to university hospitals or different types of labor induction methods on the same risks as this article. The bottom line is don't be afraid of an induction, especially if you are sick and you and the baby are at risk.

Disclaimer: While I am a doctor, I am not your doctor. The information in this blog post is for information and entertainment purposes only and are not intended as medical advice!

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