Toward the end of pregnancy, a lot of moms have questions about induction. Not knowing the exact date of baby's arrival can make planning time off work and care of other children difficult. Families feel excited to meet the baby, and women are ready to be done with all the aches and pains of pregnancy. Induction may seem like a solution to all these problems... But wait! There are many good reasons to allow labor to come on its own. Here are some points pregnant women should consider before they plan an induction:

What are some benefits of letting labor come on its own?

Typically, labor that comes on its own will be shorter and less painful than induced labor. Women usually have greater ability to move around and use alternative pain control techniques, such as a warm water bath. They are less likely to need pain medications such as epidurals. When a patient is induced, hospital procedures require continuous fetal monitoring and IV access, which may limit mobility. Furthermore, C-section rates are usually higher for induced birth, especially with first time moms.

There are also benefits for the baby if labor comes on its own. Though the process that triggers labor is not completely understood, there is evidence that babies release a hormone when they are "ready" for life outside the uterus. This may be why babies that come on their own typically adjust to breathing and eating better.

Are there medical reasons to be induced?

Yes. During pregnancy, any number of complications might cause a doctor or midwife to recommend induction. The most common are high blood pressure, preeclampsia, water breaking without labor, and passing the due date. When there are no medical complications, it's safe and recommendable to wait until 41 to 42 weeks before being induced.

When isn't induction necessary?

Inductions before 41 weeks often happen for non-medical reasons. This is called "elective" induction. Sometimes, a provider suggests induction for convenience (to avoid a weekend or holiday birth, for example). Other times, families request induction for planning purposes.

Women are sometimes given vague or weak reasons for induction, such as suspicion for a large baby, being a few centimeters dilated or a few days past the due date. If a provider is recommending induction for medical reasons, a mom should understand what evidence leads to the recommendation. An NST (non-stress test) or BPP (biophysical profile test) should be done if a provider has legitimate concerns about baby's health. If a provider has not found these tests to be necessary, induction is probably not necessary either.

How is labor induced?

Labor is induced in a hospital using at least one of three common methods: a medication that is placed next to the Cervix (Cervidil or Cytotec), a hormone that causes labor contractions called oxytocin (Pitocin), or breaking the water bag. The provider's choice of method depends on the woman's cervix.

What are some "natural" methods of induction?

· Membrane sweeping. This is when a doctor or midwife checks a woman's cervix in a way that places a finger and "sweeps" between the cervix and the bag of waters. This procedure may stir up hormones and lead to labor, or may lead to water breaking.

· Nipple stimulation (by pump or by another nursing child) and sexual intercourse may trigger contractions by releasing oxytocin.

· Castor oil causes diarrhea which may stimulate the cervix and lead to labor. Evening primrose oil also may prepare the cervix for labor.

These methods tend to work poorly when a woman's body is not ready for labor and may cause a lot of discomfort.

What general advice would you give to women about induction?

For women with pregnancy complications, induction of labor can be a life-saving and necessary procedure. Work with your healthcare team to understand the reasons for induction and what you can do to still have the kind of birth you want. Remember that it may take 12-18 hours for induction to get labor started, and then several more hours before you actually give birth. Be prepared to be patient, and make sure you choose medical providers who are willing to be patient as well.

For moms who don't need to be induced, remember that your baby plays a role in deciding when to come. Your patience in waiting will likely pay off in a shorter, less complicated labor and a healthier baby. As the days tick by, you may feel that labor will NEVER come. However, 100 percent of babies are born eventually…and good things are worth waiting for!■

Ann Ledbetter is a certified nurse midwife at Sixteenth Street Community Health Centers.

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