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This month our wonderful co-leader and local birth doula at CSRA Birth Services, Laura Selvidio, presented the topic: Letting Your Baby Choose His/Her Birthday – Why and How to Avoid an Induction.
First of all, the why’s:
You could be earlier in your pregnancy than you think you are and an induction could result in a premature baby. Most women don’t know when they ovulated and sperm can live for several days after intercourse. If a woman ovulates later in her cycle than she usually does then her baby could be a week younger than everyone thinks he/she is.
With a premature baby there can be issues with breathing, regulating temperature, and feeding. Even if you’re in the “due zone” of 37-42 weeks, the baby may not be ready quite yet. The lungs could be immature still. In a study on mice, they found that sufficient levels of surfactant – necessary for proper lung function – could be the signal that starts labor. Some babies take longer to become mature enough to really thrive outside the womb.
Inductions also carry with them an increased risk of cesarean section, low heart rate, infection (especially if your water is broken on purpose during the induction – artificial rupture of membranes = AROM), and cord prolapse (if the baby isn’t engaged in the pelvis when the water breaks).
Other potential risks include uterine rupture, bleeding after delivery due to having pitocin during delivery instead of your body’s natural oxytocin, overstimulation, placental abruption, NICU stay (with a premature baby). You could experience contractions that are much stronger and more painful for you and the baby than natural contractions are, without the natural endorphins that your body would produce in a naturally starting labor. Your uterus can become hyperstimulated, which can lead to fetal distress as the baby’s oxygen supply is cut off during longer than normal contractions, placental abruption, and uterine rupture.
An induction also increases the chances of having a malpositioned baby. Usually the body works before labor begins to get the baby into an optimal position. If you put your body into labor before it is ready, then the baby might not be in a good position yet. Once your water is broken, commonly done during an induction, the chances of your baby getting into a better position are very slim, which ties into the increased risk of having a cesarean section.
Even inductions at 40 or 41 weeks can be unsuccessful, but since postmaturity syndrome is real, it can be beneficial to at least do kick counts starting at 37-38 weeks or even get a Biophysical Profile after 41 weeks just to check on baby even if you aren’t being pressured to induce.
And how does one avoid an induction?
If your doctor is really pushing for an induction, what can you do?
If your doctor is concerned about how the baby is doing, then you can request a non-stress test or a biophysical profile to check on the baby. Be informed about your decisions and share your reasons for not wanting an induction with the doctor if he or she is open to hearing them.
Keep in mind that you can also just not show up for your induction. You are the consumer, you hired the doctor, and you can make the final decision about what happens to you and to your baby. Find out what your specific numbers are – such as with amniotic fluid levels, just as you do with other tests like the Glucose Tolerance Test. Keep in mind that low amniotic fluid levels alone are not an indication for an induction. A heavy baby alone is also not an indication for an induction and ultrasounds can be off by 2 pounds either way in estimating fetal weight.
What if it’s medically necessary?
Sometimes an induction is absolutely medically indicated and necessary. If you’re dealing with intrauterine growth restriction, pre-eclampsia, or something else serious that outweighs the risks of induction then there are some simple ways to make an induction more positive for yourself and for your baby!
First of all, know your Bishop Score. If you can wait a little longer before being induced and your Bishop Score is unfavorable – then wait! A good Bishop Score will greatly increase your chances of having a successful induction.
Try to avoid Cytotec because this drug, used off-label to induce labor, increases the risk that you will experience a uterine rupture. Ask your doctor to start you off on the lowest level of pitocin possible and then gradually increase. Some people are more sensitive to medication than others are and if you start off with too high of a dose, this can lead to uterine hyperstimulation, decreased oxygen to the baby, then more medication to slow down the contractions, and an epidural because with hyperstimulation you aren’t getting the breaks that you would normally be getting during labor.
Ask your doctor not to rupture your membranes until you’re fairly far along and the baby is well engaged in your pelvis. If your induction is not for an immediate emergency then you can always leave and go home and wait a day or two if your induction fails as long as your water is not broken. Once your water is broken, that baby is coming out in about 24 hours – one way or another!
You can also still ask for all the after-birth care preferences you would have otherwise asked for. Skin-to-skin contact with baby (if baby is stable), delayed cord clamping, quiet room, dimmed lights, etc. You will need to be on the monitors during the actual labor because of the increased risks to yourself and the baby, but if you bring a birth ball you can experiment with many different positions on or right next to the hospital bed if you’re still planning to avoid an epidural. Moving around will help the baby descend more easily with an epidural, just like it does with a natural labor.
Being educated, having a good care provider whom you can trust, having confidence in your body (you can birth a big baby!), and hiring a doula are some of the best things you can do when trying to avoid an induction or when planning a positive medically-indicated induction.
Our November Meeting will be at a NEW LOCATION!!!
For more information about our group and about events in the area, please check out our website and e-mail any questions you have to the co-leaders at Admin@CSRABirthingConnections.org – we hope to hear from you or see you soon!