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Induction of Labor: The Good and the Not-so-Good

Induction of labor, where a care provider uses a physical or medical means to bring on labor before it starts naturally, is quite common today. Medically indicated inductions, where there is some evidence that the baby or pregnant person will do better once the baby is born, are one type of induction, but there are also non-medical or elective inductions, in which someone decides, in consultation with their doctor, that induction is appropriate for them, even when it may not be medically indicated. These elective inductions are becoming more common around the world, but it’s not always clear what the pros and cons are. Read on for a discussion of possible benefits of induction, as well as potential pitfalls.

Inducing labor carries several potential benefits, according to Rebecca Dekker, a nurse and researcher as well as the founder of the website and resource Evidence Based Birth. First, it’s convenient to know about when your baby will be born, especially if you have an older child who needs care while you labor and birth their sibling. Next, induction may help you avoid complications that could arise as your pregnancy continues, which include having a big baby and developing preeclampsia. Finally, inducing labor at 39 weeks may prevent stillbirth, as well as primary cesarean births if your care provider follows best practices for inductions that don’t work the first time.

On the other hand, Dekker enumerates potential pitfalls of induction of labor in the same article from Evidence Based Birth, which include longer time in labor following induction, increased risk of infections, and that the intensity and pain of medically induced contractions can be much greater than contractions during spontaneous labor. Another potential issue with induction is that its long-term effects on the children born after labor is induced are not well understood.

In a study published May 31 in the journal BMJ Open, a team of researchers from Australia looked at the impact of inductions, including elective induction, on 474,652 births and children over the period between 2001 and 2016. 69,397 of these births happened after non-medically indicated inductions. They determined that elective induction was linked to a higher rate of interventions, including epidurals, episiotomies, and cesarean births, in first time mothers, but not in people who’d given birth before. People who had their labors induced also were less likely to have a spontaneous vaginal birth. In an intriguing look into potential long term effects of induction, babies born during labor inductions were more likely to need resuscitation at birth and to have respiratory troubles necessitating hospitalization up to age 16.

In a commentary for the website The Conversation, some of the authors on the new BMJ Open paper write: “There is no doubt induction of labor can save lives if used judiciously. But it’s a major medical intervention and so should not be offered routinely before 41 weeks without discussing the risks and the potential increase in other interventions women may not anticipate. This discussion should also include not yet knowing all the potential longer-term effects of inductions.”

So should you have an induction and, if yes, when? That’s a decision that’s reserved for you, your partner if you have one, and your care provider. Your doctor or midwife should never make the decision to induce your labor for you or without your full understanding and consent. If you feel as though you’re being rushed into something that you’re not ready for, it’s okay to ask more questions, follow up, or get a second opinion from another care provider.

If you’re ready for your baby to be born, but medical induction is not an option that feels right for you, you could always try some of the more natural induction methods discussed in this blog post from The Pulse. The advantage of most of these approaches is that if they don’t work to start labor, you haven’t started any kind of cascade of events that you can’t come back from. With medical induction, on the other hand, there are scenarios from which there’s no coming back. With artificial rupture of membranes, for instance, once your waters have been broken, there’s no putting them back in and most care providers will want baby to be born within the following few days to prevent the risks of infection.

Abby Olena
Dr. Abby Olena has a PhD in Biological Sciences from Vanderbilt University. She lives with her husband and children in North Carolina, where she writes about science and parenting, produces a conversational podcast, and teaches prenatal yoga.

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