3. Induction Series: Part 1 - Reasons for Induction of Labor

So, you’re pregnant and heading into your 37 week appointment; out of nowhere, your doctor suggests an induction of labor (IOL) at 39 weeks. You’re feeling big and uncomfortable and you’ve been ready to meet your baby since the day you found out you were pregnant, so you agree and you pick your baby’s birthday. But maybe that decision doesn’t sit well with you over the next week, so you cancel the appointment, much to the dismay of your OB. The power is in YOUR hands whether or not you are induced for labor. In my next three blog posts we’re going to review some of the most common reasons that OBs give for inducing, the different types of induction procedures and the risks that go along with labor induction. 

Before we dive into what reasons they’ll give you for scheduling an induction so badly, what’s in it for them? Why do they ACTUALLY want to induce you? Staffing and holidays. It’s all because they want to know how to staff the hospital floor in order to save themselves money or because they don’t want to be on call for your birth on the 4th of July because they’re supposed to go tubing down the river that day. That’s it. Now, let’s get into all the reasons an obstetrician will try to use to coax you into an induction so that they can attend their neighbor's barbecue.

Before I discuss the ARRIVE trial, it is essential to know that you should be skeptical of any medical trials and you should ALWAYS look at who is funding them. Just because a study says that something is true, doesn’t necessarily mean that it is. Cherry-picked data is not something that doctors should hang their hat on, but because it fits their narrative and can be used to coerce women into doing what they want them to do, they are cited as gospel truth and we laymen who don’t know what all those big words mean couldn’t possibly interpret the data for ourselves or be critical of it. 🙄 The ARRIVE trial is a recent study that was done and will be cited by many OBs that suggest that ALL pregnancies should be induced at 39 weeks because it decreases the chance of a cesarean from 22% to 19%. Ok, when you see those numbers do you really think that a 3% change would be enough to risk pulling your baby out of the womb early? On top of that, ANY blanket statement like that should alarm you. When your doctor isn’t looking at YOUR chart and YOUR pregnancy specifically and is making suggestions on what do to about YOUR birth based on a study done with other women, I would second guess anything he says. 

I will freely admit my biases always because we all have them and the fact of the matter is that I am completely triggered by unnecessary inductions. The disrespect that doctors have for the baby and the normal birth process, I just find really repulsive. The one that’s most triggering for me is the “you’re past your due date.” This absolutely ridiculous reason for induction is why my third didn’t get to choose her own birthday. I was -God FORBID- 3 days past 40 weeks, but that Advanced Maternal Age HIGH RISK label was slapped on my chart. My doctor said she “didn’t want to let me go past 40 and 3” because of the dangers of increased risk of stillbirth and they used that to scare me into an induction because I wasn’t educated about how stupid that reason actually was and how small the numbers and risks really were. They claim that the placenta ages and stops working, and it’s true that the placenta changes and can have some calcifications on it in those later weeks, but there is no evidence that shows that it stops working properly for every woman at a certain point in time. It is true, some women’s placentas have deficiencies, but there has never been a causal link found between placental insufficiency and later term placentas. There is no “sell by date” on your placenta. It is an unproven theory from the early 1900s.

It’s funny, they like to throw in, “well you’re past your due date, so your placenta is going to stop working and we also don’t want your baby getting too big.” How will my baby get too big if she’s not getting the nutrients she needs through my placenta? Oh, that’s right, you’re bullshitting me. On the subject of the “big baby,” ultrasound machines are NOT an accurate predictor of weight. In fact, women who are induced for a “big baby” will often birth an average sized baby, sometimes even below average. My  personal anecdotal case of this instance happening in my life was when sister-in-law was induced for a “big baby” and he was 5 measly pounds, came out too early, had feeding issues, and was started on formula. Then my sister-in-law went on to blame herself for “not producing enough milk” but I won’t go down that rabbit hole with you guys just yet. We’ll save that for another blog, but bravo, doctors. You’re great at your job. 🙄👍🏻 

Advanced Maternal Age (AMA) or “geriatric pregnancy” as it’s so lovingly called 🤮goes along with the aging placenta “past your due date” theory mentioned above, but they just smoosh the two labels together to make it appear scarier. And it clearly works. It worked on me as I said earlier and if you don’t know that just because you are over 35 you’re not at significantly increased risk, then you give into their coercive tactics and sign yourself up for an induction. I plan on doing an entire blog post on how they use statistical terms to make us comply, but your ABSOLUTE risk increase from being AMA is insignificant. Don’t let them convince you that your uterus is deficient just because you had your 35th birthday. 

A lot of pregnant women have that feeling: Uh oh. Did I just pee my pants? When a woman’s water breaks, without fail that is always the point she is rushed to the hospital in movies and TV shows, but maybe heading to the hospital just because your water broke isn’t the best thing to do. When you call your OB to let him know you think your water broke, he’ll tell you that you’re on the clock now, you need to come in and be tested to see if it did break and you need to deliver within 24 hours. And yep, you guessed it. That’s total crap. Labor may start on its own now that your membranes are ruptured, but they may take a while. OBs claim that your risk of infection goes up if you go past 24 - 48 hours, but it turns out that if you don’t have RNs and OBs shoving their hands up your vagina and touching your cervix and bag of waters, your risk of uterine infection isn’t that high. On top of that, your amniotic sac can actually close back up if it’s a small leak. This is where your intuition comes into play. If your water breaks and you are gushing amniotic fluid and labor doesn’t start, you need to do what feels right to you.

It turns out if your water breaks and you have all sorts of different people shoving their hands up your vagina, even with sterile gloves, you could very well end up with chorioamnionitis, which is a fancy term for a uterine infection, and this is a reason to induce, but fortunately, the more we keep foreign objects out of the vagina, the less likely it is to happen, but if you start to experience a fever after your water breaks, then that may be an instance where an induction is indicated. 

If you were diagnosed with gestational diabetes or if you have type 1 diabetes (T1D), your OB may have discussed induction right off the bat with you. And it is true, people with uncontrolled gestational diabetes or T1D can have larger babies than typically seen with those that don’t due to the elevated sugar circulating in the bloodstream which can lead to problems like shoulder dystocia during a vaginal birth. But the power is STILL in your hands. If you keep your blood sugars well managed through diet and exercise, the American College of Obstetricians (ACOG) doesn’t even suggest induction until 40 weeks and 6 days and even after that, the power is still in your hands to say, “no, I’d rather wait.”

Intrauterine Growth Restriction or IUGR is another reason given for induction and this issue can cause problems with the baby, but studies show that the baby doesn’t have any more or less of the complications that can possibly arise when they are induced versus when they are expectantly managed or when mom is able to go into labor on her own. In fact, in this particular study, more babies that were induced for IUGR went on to spend time in the NICU than those that were allowed to come out on their own terms. The study can be found here.

All of this being said, there are REAL reasons to induce a pregnancy. If you’ve been having high blood pressures throughout your pregnancy or if they start and are consistently high throughout your third trimester, preeclampsia is a real risk and it does cause maternal deaths. Even with these risks, the subject of blood pressure in pregnancy is more nuanced than that, and I do NOT think that just because you had a pressure of 140/60 right after you were running up the stairs to not be late to your appointment is a good reason to be induced. Some women have white coat syndrome and anxiety triggers an increase in blood pressure, so if you think this is why your pressures are consistently higher, then I would suggest going to a drug store with one of those blood pressure machines and checking it there, or have a nurse friend come over and check it, but you should also know that preeclampsia is a danger and we need to be careful when our pressures are higher. 

Oligohydramnios is when you are deemed to have low amniotic fluid levels, but the diagnosis of this is not exact, just like when they try to estimate the baby’s weight. It’s often wrong. Not only is it often wrong how low the levels are, but you can also affect your amniotic fluid levels by hydrating, even though doctors don’t like to admit to it. Yep, sometimes one day of drinking lots of water is all it takes to get those levels back up. Amniotic fluid levels dropping is also biologically normal. This happens to every woman as they are getting closer to delivering. This is again, another time when critical thinking and informed decisions need to be carefully made by the mother.

Placental abruption or when the placenta is coming away from the uterine wall, doesn’t always call for induction, but that would be an instance where my intuition would maybe tell me that baby may be safer out rather than staying in depending on how far along I was in my pregnancy. 

Some doctors will induce for decreased fetal movement and there are times that there is a problem going on with the baby when this is a great move, but you have to remember that farther along in your pregnancy, baby stops moving so much because they have less room, so that’s a completely normal thing to happen, but again this topic is nuanced and you have to pay attention to what is going on specifically with you. Is baby moving a lot less than a month ago, or are you noticing a distinct lessening in movement from yesterday? Pay attention to your specific case, but this is an instance that can be dangerous for baby.

Along with these other reasons you need to weigh the pros and cons, if being pregnant is having severe psychological impacts on a mother and she just can NOT go on anymore and it is affecting her daily life and possibly her other children, then YES, by all means, she will more likely be better off by having an induction and the baby might have a mother in a better state of mind to care for her than if she were to stay in utero another week. This situation is all about trade offs and we need to consider external factors like how the mother is taking care of herself and those around her who depend on her. 

When your doctor suggests an induction, it is on you as the mother to do your own research and to make an informed decision. You cannot rely on the doctor to give you true informed consent, so it’s on YOU to find out more about your specific diagnosis from the doctor and whether you think an induction should be performed or not.

None of this is medical advice. You should educate yourself and consult YOUR INTUITION about whether IOL is right for you and your baby.