Medical Inductions - To Induce Or Not To Induce
By Kimberley Fernandez - CLD, CCCE
Kimberley is a dual certified doula and childbirth educator, and a certified sleep consultant. She has been working with pregnant and new families in their birth and postpartum journey since 2006, and currently teaches prenatal classes virtually as well as offering virtual classes through her teaching portal "The Birthing Room"
Having a medical induction can be a difficult decision. It could also be a very easy decision. Having one requires a discussion with your care provider, asking about ALL the benefits AND ALL the risks of starting labour by medical means. Weighing that information, and seeing how you feel about it all. Below is my induction story with my first son
There are many reasons why a medical induction may be necessary. For me the reason was, as I believed it to be, that I was 8 days past my estimated due date.
Once I hit 40 weeks, the midwife I was working with, suggested an ultrasound to ensure baby and placenta were well, and to do a series of stretch and sweeps. This terribly uncomfortable procedure involves the care provider inserting a finger into your cervix, during a vaginal exam and sweeping around the top of it to dislodge the amniotic sac from the top of the cervix and irritate the cervix into loosening up and getting going. They are as uncomfortable as they sound. And I had three of them over the span of a week. But none of it worked. Not even a little.
Eventually the midwife strongly suggested that more substantial medical help would be needed to get my labour going. I jumped at the chance. I was approaching 41 weeks, I was tired, and heavy and winter was upon us. And unbeknownst to me, multiple ultrasounds were indicating my baby was quite big. But my midwife chose to keep that information from me. There is a part of me that is glad about that because it would have scared the hell out of me and a part of me is very angry about that as I was making a decision to induce without all the pertinent information.
In fact, if I had been able to discuss this aspect of my pregnancy and birth, I may have chose a very different journey. I may have opted for a surgical birth. And this is the reason I want every birthing parent to ask for ALL the benefits and ALL the risks, not just what your care provider choses to share with you.
A suspected big baby is another reason why medical inductions are done and often comes hand in hand if you are experiencing gestational diabetes. I was not, I just seem to grow big babies. With gestational diabetes you may end up growing a baby bigger than what you would without it. Especially if the diabetes isn't being managed well with diet alone. These inductions are often scheduled for 38 or 39 weeks gestation.
On the flip side, and I don't know this from personal experience as I grow huge babies, but if your care provider is concerned that baby is too small. Or what is referred to as Intra Uterine Growth Restriction. If they suspect a small baby, you will go for a few ultrasounds to make sure the placenta, fluid and cord are working well but usually if baby slips below the 10th percentile or is definitely shrinking in percentile, they may feel baby is safer on the outside.
Another reason for induction is if you are of Advanced Maternal Age. Studies have shown that as you age, your risk of having a still birth increases. And while these risks are actually quite small, less that a percent chance, the risk is there and it can be catastrophic and devastating. You can read more about the risk here:Evidence on Pregnancy At Age 35 And Older
Pre-Eclampsia is the final reason we will discuss for a medical induction. As your pregnancy advances your care provider will be watching for signs of pre-eclampsia. This is a very serious condition that can pose great risk to the birthing parent. High blood pressure, headaches, dizziness, spotty vision, rapid swelling of the hands and face and protein in your urine can indicate you have pre-eclampsia. If left untreated, the birthing parent is at risk of stroke or death. I know that sounds horrible. But this is why your care provider will attempt to lower your blood pressure through medication, and if that doesn't work then an induction is recommended.
There are definitely other reasons for an induction, reasons unique to your medical history, so if one is being suggested, but it wasn't part of your original plan, then ask the questions you need to ask, and trust your instincts so that you can make the best possible decision for yourself, your family and your baby.
Next week we will discuss how medical inductions are done, getting into the procedures that are used to start your labour and keep it going.
Want more information on Medical Inductions? Check out my virtual class Induction 101.
