“One of the choices faced by as many as 1/3 of U.S. women in late pregnancy concerns the artificial induction of labor. There are legitimate medical reasons for induction. These include cancer, hypertension, diabetes, kidney disease, a small-for-dates baby, a decrease in the amount of amniotic fluid… In these cases, the risks posed by the induction method are more likely to be outweighed by those associated with waiting for the natural process to kick in. Many studies agree that fewer than 10% of women require labor induction for medical reasons. A consensus meeting organized by the World Health Organization on Appropriate Technology for Birth held in Fortaleza, Brazil, in 1985 recommended that ‘No geographic region should have rates of induced labor over 10%.’” - Ina May’s Guide to Childbirth
What is induction?
Labor Induction is a procedure used to stimulate the uterus to contract before labor begins on its own. It is technically an intervention of the natural process of labor and birth. Here are some common methods used to induce labor in hospitals:
Pitocin - synthetic oxytocin that mimics the body's natural oxytocin
Prostaglandins - synthetic oxytocin inserted into the vagina
Misoprostol - also known as Cytotec - originally created to prevent and treat stomach ulcers - never approved by the FDA (food and drug administration)
Sweep of membranes - manually separate amniotic sack from lower part of uterus
Rupture of membranes - breaking the amniotic sack
Foley balloon catheter - a deflated balloon is inserted into the uterus and then expanded, manually dilating the cervix
Why avoid induction?
There’s a cascade of hormones (oxytocin, beta endorphins, adrenaline, noradrenaline, prolactin, etc.) occurring in birth that optimize survival for mother and baby, promotes successful breastfeeding, and initiates secure bonding. Labor induction is a disruption to our hormonal physiology. In other words, if there are disruptions to the birth process, it can potentially cause complications requiring further intervention that wouldn’t have otherwise been needed. Some risks include:
Hypertonic uterus - rapid, intense contractions
Baby more likely to pass meconium
Umbilical cord prolapse
Emergency cesarean section
To learn more about how hormones optimize birth outcomes, listen to the Healthy Births Happy Babies Podcast Episode 36 - Nature's Hormonal Blueprint for Labor
Five Ways to Avoid Induction
1. Your care provider
Choose a care provider who has a similar birth philosophy as you, is open to listening to you, and agrees to your preferences. Ask what their induction and cesarean rates are. If your care provider isn’t a good match, find a new one. It is crucial that your birth team fully supports you. Hiring a doula can also be very beneficial.
Listen to the Birthful Podcast Episode 30 - Choosing Your Care Provider
2. Physical & emotional wellness
Eat nutrient dense whole foods, drink lot’s of water, stay active, and reduce your stress during pregnancy. This promotes balance and a well-functioning body. When the body is healthy, hormones are more able to signal the body to go into labor at the optimal time.
Squats, yoga, meditation, swimming, walking and hiking
Organic fruits and vegetables, grass-fed or wild-caught meat, whole milk organic dairy
Walnuts, almonds, pumpkin seeds, sunflower seeds
Good oils like raw unrefined coconut oil, extra virgin olive oil, organic butter or ghee
Listen to Healthy Births Happy Babies Podcast Episode 5 - The Essentials of Prenatal Nutrition
Check out Spinningbabies.com for awesome exercises for optimal fetal positioning
Get chiropractic care regularly. In pregnancy, chiropractors make adjustments to restore physiological balance to the pelvis. Chiropractic care is designed to reduce interference to the nervous system, enhancing normal bodily functions, and optimizing the environment for birth.
Learn more about chiropractic care during pregnancy by listening to this Healthy Births Happy Babies Podcast Episode 14 - Natural Childbirth & The Webster Technique
4. Due date verses guess date
Keep in mind that “due dates” are actually “guess dates”. Nobody can predict exactly the day your baby will be ready to come into the world. Some babies come early because they could get better care outside of the body, and some babies stay in as long as they can because they’re getting the perfect amount of nourishment in your womb. Going past your due date is not as risky as many doctors make it out to be.
Listen to the Birthful Podcast Episode 43 - The Problem with Due Dates
5. Encourage natural onset of labor
If evidence-based medical reasons determine that you need to be induced, you might try natural methods first. These will not disrupt your very important flow of hormones that promote healthy labor:
Relax, de-stress, watch movies that make you feel good
Have sex, masturbate, nipple stimulation
Dance or go for a long walk
Acupuncture, acupressure, chiropractic adjustment
Apply evening primrose oil to the cervix
Herbs or castor oil (check with your care provider and evidencebasedbirth.com before doing this)
What if my doctor tells me I need to be induced?
Your care provider should be clear with you about medical terms and actual risks. If they are not clear with you about this, ask questions. Ask for more detail about how this actually impacts you and the baby. Sometimes this means getting a second opinion or even switching care providers.
Common reasons doctors claim induction is necessary...
“Your baby could die.”
Always ask why this is a risk, what the statistics are, and if there are any alternatives!
“Your amniotic fluid is low.”
There is no evidence that inducing labor for isolated oligohydramnios (low fluid) at term has any beneficial impact on mother or infant outcomes. You can increase your amniotic fluid by drinking lots of water and staying hydrated. You also want to make sure you're being measured correctly. (Learn more here.)
It is the baby who triggers your body to go into labor and it's common for women, especially first time moms, to go past their due date. As long as the baby is doing well, it is safe to wait until the natural onset of labor. It's more of a "due month" anyway.
Listen to the Birthful Podcast Episode 43 - The Problem with Due Dates
“Your baby is large.”
It is impossible to know exactly how much a baby weighs while still in the womb. Whatever your doctor tells you will simply be an estimate. Your body changes throughout pregnancy and birth to expand and open to help your baby through. And your baby will rotate throughout labor to fit just perfectly through your pelvis. Remember, we've been doing this for thousands of years.
"Your bag of water has ruptured."
If your amniotic sack has ruptured on its own, labor will most likely start within 12-24 hours but it can take longer. If labor doesn't start on its own within that time, hospitals generally want to induce for risk of infection. However, the "24-hour clock" for giving birth is no longer based on evidence. If your amniotic fluid is clear, you decline vaginal exams, stay out of the bath tub, baby's heart rate is good, and you don't have a fever, waiting up to 2-3 days for labor to begin on its own is an evidence-based option. (Learn more here.)
Evidence and Induction
Doctor Stuart James Fischbein, an obstetrician who worked in hospitals for 28 years and now practices home birth midwifery, shared some valuable guidance when asked about low amniotic fluid and I believe this can be applied to many situations…
“‘Low is not a medical term. There are many parameters to indicate fetal wellbeing. Fluid volume is only one indicator. It can be worrisome in some situations but I think most of us have seen it used inappropriately at times to convince a woman to undergo an unnecessary intervention… Cases must be individualized and that is where the classification breaks down. Those that like to induce will always find a reason.”
Listen to this Healthy Births Happy Babies Podcast Episode 60 with Doctor Stu - Pregnancy is NOT a Disease that Needs to be Treated Medically
Many women are faced with the decision of inducing labor. Many of them go on to have perfectly normal, healthy births. But there are a great deal of women who have regretted being induced because it caused complications and further interventions to what could have been a normal, healthy birth. And they may have made a different decision if it was truly informed consent.
The choices you make as a parent are important but what’s really key is that YOU are making them. Your care provider is there to care for you and guide you. Ultimately, you are in charge of your body and you have the power and intuition to choose what’s best for your birth.
Please share your experience of being induced.
Would you make a different choice next time?