Induction of Labor Part 1: Definition and Indications
If you've been anywhere near the birth world recently you've probably known someone who had an induction or was at least offered one. According to birth certificate records induction of labor has nearly tripled in the past 30 years to roughly 25-30% of term pregnancies. Out of those, studies show anywhere from 10%-30% are for non-clinical reasons, or "elective".
An induction is using chemical or mechanical means to start contractions when your labor hasn't started on its own. There are legitimate medical reasons that an induction of labor might be recommended as early as 37 weeks gestation, or even earlier for severe complications. Elective inductions are not recommended before 39 weeks.
Some of the medical reasons for induction include the following:
Chronic health conditions such as heart, lung, or kidney disease. This can include chronic hypertension and/or diabetes.
Gestational Hypertension High blood pressure that starts after the 20th week of pregnancy is called gestational hypertension. This can cause problems with the placenta getting enough blood and passing enough nutrients on to the fetus.
Uncontrolled gestational diabetes Ongoing high blood sugar can cause problems such as premature birth, abnormally large babies, and low blood sugar for the baby. It can also cause complications for the mother including high blood pressure,
HELLP Syndrome, which can be related or unrelated to hypertension. HELLP is an acronym for Hemolysis, Elevated Liver enzymes, and Low Platelets. This disease is not well understood but can have devastating effects on the mother and child. The only treatment for this is delivery of the fetus no matter what the gestational age.
Problems with the placenta Placenta problems can have many causes including diabetes, hypertension, and CoVID. An ineffective placenta does not give the baby the oxygen or nutrients he or she needs to develop. This can lead to Fetal Growth Restriction, and can also cause complications during delivery if the placenta can not keep up with the oxygen demands during labor.
Decreased amniotic fluid Decreased amniotic fluid can be a sign of trouble with the placenta, problems with your baby's kidneys, and more. Decreased fluid can result in abnormal growth, joint issues in the baby as they didn't have space to move their limbs in utero, and trouble during birth such as cord compression.
Uterine infection An infection of the uterus can make both mother and baby very sick very quickly. If there is any reason to believe there is a uterine infection it is best to deliver the baby sooner rather than later.
PROM (Prelabor Rupture of Membranes) When your water breaks it creates an opportunity for germs to enter the uterus and create an infection. This is more likely if you are GBS positive. Water leaking can also reduce the amniotic fluid to an unhealthy level if it goes on too long. Depending on your risk factors it is beneficial to get contractions started within 1-3 days after your water breaking.
"Post term", Pregnancy that lasts 42 weeks or more At 42 weeks the chance of complications begins to climb faster
*The ARRIVE Trial ("risk reducing") this controversial study was completed in 2016 and published late 2020. The results of this particular study showed a less than 4% reduction in cesarean rates for women who have never given birth before if induced at 39 weeks.
An elective induction is exactly that, one you have elected to schedule for non-medical reasons. People may choose an induction to avoid a certain holiday or a family member's birthday. Some choose to schedule an induction related to high levels of anxiety if they feel less anxious knowing exactly when the baby will arrive. And others might choose an induction because they are simply ready to be done being pregnant.
The upcoming posts in this three-part series will discuss the methods of induction, and the benefits and risks associated. Future posts will discuss pregnancy complications in more detail.
Resources
Labor Induction | ACOG. www.acog.org/womens-health/faqs/labor-induction. Accessed July 25, 2023.
Simpson, Kathleen Rice PhD, RNC, CNS-BC, FAAN. Trends in Labor Induction in the United States, 1989 to 2020. MCN, The American Journal of Maternal/Child Nursing 47(4):p 235, July/August 2022. | DOI: 10.1097/NMC.0000000000000824
Oligohydramnios: Causes, Symptoms, Diagnosis & Treatment. Cleveland Clinic. my.clevelandclinic.org/health/diseases/22179-oligohydramnios. Accessed July 25, 2023.
Oligohydramnios | March of Dimes. March of Dimes. www.marchofdimes.org/find-support/topics/planning-baby/oligohydramnios. Accessed July 25, 2023.
High Blood Pressure During Pregnancy | cdc.gov. Center for Disease Control. www.cdc.gov/bloodpressure/pregnancy.htm. Accessed July 25, 2023.