Practices that Promote Healthy Birth Series: Let Labor Begin on its Own

I cherish the opportunity to be able to write here on Giving Birth with Confidence, so I put a lot of thought into what I want to write about, or what I think women will get the most out of. I originally thought of the idea to write a single post about the six Lamaze Healthy Birth Practices. When Cara suggested making it a six post series, I couldn't thank her enough for the idea!We'll start at the top with "Let labor begin on its own." With nearly half of all women being induced today, avoiding labor induction it not as easy as some may think.Lets face it, the last couple weeks of pregnancy are miserable, uncomfortable, and downright painful for some women. One thing women do not always take into consideration at the end of pregnancy are the risks of labor induction and the benefits of allowing labor to start on its own without medical intervention to jump start. There is little information being given to pregnant women about labor induction and the risks associated with the procedure.Why should women let labor start on its own?There are a variety of different reasons :

• Pitocin contractions are much stronger than contractions of a normal labor. I can attest to this as I have had pitocin with one labor, and a natural labor with my second child. Pitocin causes much stronger contractions which can have an impact on mom and baby.
• Induction normally requires an IV line, which can make getting comfortable, changing positions, or moving around much more difficult.
• Because induction drugs like pitocin cause longer and stronger contractions, this can can cause the baby to go into fetal distress, which is typically exhibited by heart rate issues.
• When your labor starts on its own, in most cases, you know that your baby is physically ready to be born.

A 2007 research study showed an increased risk for complications in induced labor which included :

• Increased use of vacuum extraction, or forcep-assisted delivery.
• Cesarean section (40% of all inductions will end in a cesarean delivery)
• Increased use or need for an epidural, or medication based pain relief methods.
• Babies born with low birth weight.
• An increase in late pre-term deliveries. (33-36 weeks gestation)
• Longer hospital stays.
• Increased NICU stays for the newborns.

How do you know if labor induction is necessary?In some cases and conditions during pregnancy, a labor induction may be medically necessary, and it is important you speak with a trusted provider about the risks and benefits to weigh out your own situation.The American Congress of Obstetricians and Gynecologists (ACOG) formally known as the American College of Obstetricians and Gynecologists has set guidelines for necessary labor induction. The six situations that ACOG has identified and recommended induction for are:

• Ruptured membranes for longer than 12-24 hours. Meaning, if your water has broken, and your labor has not started within 12-24 hours, augmenting of labor may be medically necessary. This does not mean, however, that the baby must be delivered within 12-24 hours of the water breaking. It means that your labor may need to be induced to speed up the process toward birth.
• You have an increase in your blood pressure caused by pregnancy or a condition called preeclampsia.
• Your pregnancy is post term, or overdue. The definition of "overdue" is over 42 weeks gestation.
• You have other health issues such as diabetes or gestational diabetes that could have an impact on the health of your baby.
• Your baby is growing too slowly, or may be suffering from a form of intrauterine growth restriction (IUGR).
• An infection in the uterus.

When is induction not necessary?In many cases taking place today, induction is not medically necessary. Some of these reasons include:

• A suspected "big baby." If you and your baby are healthy, an induction for suspected fetal macrosomia (a baby bigger than 8 pounds 12 ounces) is not a reason for an induction. Plus, doctors cannot accurately predict the size of your baby -- even with an ultrasound.
• You are uncomfortable.
• Your amniotic fluid is low, but you and your baby are otherwise healthy.

Nearly every single woman I know (myself included!) is uncomfortable toward the end pregnancy! There is a bowling ball sitting on our bladder and grinding into our pelvic bone, for crying out loud! Consider it preparation for the many uncomfortable situations motherhood will bring your way, ha!What questions should you ask your provider if induction is suggested?Being a critical thinker, investigator, and overall research into your care is almost always a smart idea, and will help you in the long run. I learned this through my first pregnancy, and it made my second pregnancy and birth much more pleasant. Some sample questions for your provider include:

• Why are you recommending labor induction?
• What are the risks to me and my baby if I wait for labor to begin naturally?
• Can we try more natural methods of induction before using drugs?
• What natural methods of induction do you recommend?
• Are there any research studies for my situation that show how not having an induction can increase the likelihood of an unhealthy outcome?
• Is my induction likely to be successful?
• What is my Bishop Score and how does that impact my success rate?
• Is my cervix ripe? (Your provider can tell you if your cervix is ripe. Women who are induced before their cervix is ripe are much more likely to have cesareans, even if cervical ripening drugs are used.)

One important thing to remember: A due date is not a deadline! Studies have shown that estimated due dates, in many cases, are up to two full weeks incorrect in either direction. Even with advances in ultrasound technology, and other methods for dating a pregnancy, there is still room for error.Want to know more about letting labor begin on its own? View this short, informational video from Lamaze.

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