The message is finally getting out. Preterm induction (before 39 weeks) is not good for babies. But what about induction at 39, 40 or even the common 41.6 weeks? The rate of induction of labor in the U.S. has risen from 9.6% in 1990 to 25.7% in 2018, including 31.7% of first-time births. but unlike Cesarean rates (15%), we don’t really have a figure that represents the optimal induction rate.
in 2018, A Randomized Trial of Induction Versus Expectant Management (ARRIVE) results were released that encouraged elective induction at 39 weeks as a way to reduce Cesarean rates. It has been hotly debated since, but has most likely increased induction rates even further since its release.
The bottom line is simple. If there is not a clear evidence based medical reason for induction, it is considered safe to wait for labor to start on its own. If your provider wants you to be induced, you should be very clear on exactly why they think you need an induction and how it will benefit you and your baby. You should be told the risks of both inducing and waiting, and your provider should be able to point you to current peer reviewed studies that back up their recommendation.
There are many valid reasons for induction, where the preponderance of evidence shows benefits to mom and baby that far outweigh the risks of induction; things like a baby who is not growing and thriving in the uterus, or pre-eclampsia. These are the times when we are thrilled that we can do something to help mom and baby. Yay! These are times when we should feel happy and relieved that induction can help. But many babies are induced simply because they are past an arbitrary due date that may or may not even be accurate, because they are “too big”, or because believe it or not – mom doesn’t want to be pregnant anymore.
This is your birth, your body and your baby and you are responsibile for the decisions about them. If your provider has given you an induction date, you should fully understand why you cannot safely remain pregnant anymore. You should know your options and your providers recommendation for method of induction.
Ask questions, do your research. Your provider should be happy to explain their recommendation. If you are not happy with their answers get a second opinion. Sometimes practitioners – even in the same practice – have differing views. Weigh the evidence and risk percentages and be certain you are doing something to help you and your baby’s health.
No one comes with handcuffs and drags you to the hospital to be induced. This is your decision. Perhaps your first serious decision as a parent. You should be a willing, and educated partner in any induction plan.
If you are not happy about your induction, it you don’t have the feeling of “Yay! I am happy and relieved that induction can help!“, it means your provider hasn’t done their job, and neither have you. If you are not happy about your induction you should reevaluate your options
Induction links and references:
Best Evidence: Induction of labor
Evidence on Inducing Labor for going past your Due Date
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