Too many moms have approached me about their doctor threatening induction lately. I am currently supporting a mom who is past her "due date" and I have been struck at the difference in the management of her care (she is birthing at a birth center with midwives). Instead of making comments about a big baby, the midwives affirm that all is well with mom and baby (more on the midwives' protocols follows below). So here are more thoughts on the management of induction.
1. Best case scenario, induction shouldn't even be discussed unless there is a problem with health of baby/mom (in other words, if baby would fare better outside of the womb rather then in). I would love to see more doctors/midwives patiently wait for baby to come.
2. Since scenario number one isn't really an option in most areas of the U.S. unless you are having a home birth with a Certified Professional Midwife (and I am all for that!), here is a typical way induction is handled at a local birth center. I think it is a good balance between waiting for baby to come and acknowledging the reality that birth centers are backed up by hospitals that have strict induction protocols that must be followed if they are to continue having hospital back-up. I wonder why more OBs can't have a similar induction protocol....
- Around 41 weeks the midwives talk to mom about ways mom might get labor going (lots of walking, sex, spicy foods, evening primrose to soften the cervix, etc.)
- At 41 weeks and three days, they encourage mom to really work on the things that help get labor going (see above) often adding castor oil into the mix and your membranes can be stripped as well.
- At 41 weeks and 5 days, the midwives are obliged to discuss aggressive induction. This might mean a foley bulb or breaking the bag of waters. If your cervix is hard and not effaced, you will probably be scheduled for a hospital induction which means pitocin etc.. The reality is that baby needs to be delivered by 42 weeks in order to keep in good standing with the hospital.
- Generally NO VAGINAL EXAMS unless mom requests or to determine if cervix is ripe enough to do a birth center induction (close to 41 weeks and 5 days).
- Bio-physical profiles and non-stress tests will be ordered as needed to ascertain that baby is doing well (and to prove to induction-happy hospital that baby is indeed doing just fine).
The above scenario is NOT how many doctors I know (or the doctors moms tell me about) handle induction. At 40 weeks (instead of 41 weeks) they schedule your induction (which will usually happen by 41 weeks, 41 and a half if you are very lucky) and may use the threat of a big baby to silence the mom's questions. End of story. This is NOT the way to do things. You and your baby deserve better. Induction can increase your cesarean risk by 50%-250% (Henci Goer)! Please read this article on induction if you would like to know more: http://hencigoer.com/articles/elective_induction/. And on the big baby note, please read this: http://parenting.ivillage.com/pregnancy/plabor/0,,8nbq-p,00.html. Studies show that inducing big babies DOES NOT, repeat DOES NOT reduce cesarean, shoulder dystocia or birth injury (the complications associated with big babies, although many of these complications arise from birthing a big baby on your back with an epidural). If you are having a big baby and want to reduce your risk, make sure you don't get an epidural, stay mobile, and be certain that your care-provider is comfortable delivering babies when mom is in an all fours position.
Moms who are being threatened with induction, my heart goes out to you, this is the LAST thing you need when you are about to have a baby, but have faith, your body knows how to give birth, your baby will come, and your body CAN birth a big baby, much depends on staying mobile and finding a good position.