Inducing Labor: When Mother Nature Needs Help Making You a Mother Sooner
When should labor be induced?
Each decision to induce labor is based upon the balance between the risks if
the baby stays inside the mother versus those if the baby is born, to both the
mother and her child. Induced labor is considered when the merits of delivering
sooner outweigh the risks of delivering later. There is only one indication
for 'routinely' induced labor: in "postdates" pregnancies which have
exceeded 42 well-documented, completed weeks. This affects approximately one
in 10 pregnancies and is defined as pregnancies which go more than 14 days past
the assigned due date. These pregnancies have been shown to have greatly increased
risk of complications for the baby. For example, studies of postdates pregnancies
have found that the perinatal death rate doubles after 42 weeks of pregnancy
and triples after 43 weeks. Even with the sophisticated monitoring techniques
we have today, nearly 1 in 1000 babies will die unexpectedly before birth in
pregnancies beyond 42 weeks.
In general, a fetus is better off growing inside the womb until "term",
the point at which it is fully developed and ready for birth. There are conditions,
however, which affect the fetus which make earlier delivery--and treatment or
continued growth outside the womb--preferable. In addition to postdates pregnancy,
these include macrosomia (when the fetus is excessively large); decreased amount
or certain infections of the amniotic fluid; decreased fetal movement; intrauterine
growth retardation (IUGR--when the fetus is not continuing to grow properly);
maternal drug abuse or other toxicity; complications from blood factor incompatibility
with mom; certain complications with multiple gestations; and intrauterine fetal
There are also conditions in which the mother's health is at risk if the pregnancy
is further continued, and induction may be indicated. These conditions may
include uncontrolled maternal diabetes, pregnancy-induced hypertension, preeclampsia,
eclampsia ("toxemia"), maternal heart disease, maternal renal failure,
maternal stroke, certain unstable psychiatric conditions, certain infections,
certain liver or autoimmune diseases, or cancer. While these conditions may
also sometimes require planned or immediate cesarean sections, induced labor
is often a preferred first step. Other conditions in which induction of labor
are increasingly common include premature rupture of membranes (PROM--when the
mom's water breaks before she goes into labor) and cases where labor has begun
and then stopped or in which it is progressing too slowly.
Some physicians believe that well-timed inductions can actually prevent the
need for cesarean sections in some women, particularly those with large babies,
babies in the breech position, or multiple gestations (twins, triplets, etc.).
These decisions must be made on an individual patient basis, however.