Are we there yet?
The last few weeks of pregnancy can
seem endless, and it's tempting to ask
your doctor to induce labor to get the
whole thing over sooner —especially
in the hot, uncomfortable summer
months. Or perhaps your obstetrician
will be going out of town soon, and he
suggests bringing on labor when you
get near your due date.
But maybe you shouldn't try to fool
with Mother Nature. Investigators have
found that when women undergo elective
induction, they are more than twice
as likely to have a cesarean delivery,
according to the authors, who recently
published their findings in the journal
Obstetrics Gynecology. When women giving
birth for the first time have an elective
induction, they are almost three times as
likely to end up with a cesarean.
And cesarean deliveries are not without
risk. Compared to women who have
regular vaginal deliveries, those who
have cesareans are nearly twice as likely
to be back in the hospital within 60 days,
according to a study in a May issue
of the Journal of the American Medical
Association. Cesarean births carry the risk
of life-threatening blood clots, excessive
bleeding, infection, and tearing of the
uterus or of the surgical incision, among
others.
Vital Information:
• Inducing labor in a pregnant woman
increases the chance the woman will
require cesarean section.
• Elective inductions that do not result
in cesarean sections cost more money
per patient and require more pre-delivery
time in the hospital, compared to
spontaneous labors.
• There are times when a woman or
her baby has a medical condition that
warrants inducing labor, but otherwise
women should be allowed to go into
labor naturally.
Excerpted from Web MD’s article: Inducing Labor:
Don’t Force Mother Nature’s Hand by Paula Moyer
Inductions After Previous C-Section
Lead to Potential Future Uterine Rupture.
The frequency of elective inductions have risen dramatically. They are
primarily for scheduling convenience. Either the planned date works out
better for the doctor, or the parents are given an option “when to deliver”
for their personal convenience.
Although inductions have their potential hazards in any birth, July OB/Gyn
2001 reports that inducing a woman for a birth after a previous c-section
increases the possibility of uterine rupture.
These findings contrast sharply with the risk of uterine rupture in a natural
Vaginal Birth After Cesarean. Women should continue to opt for VBACs and
insist on their right for natural childbirth. It appears, even when there are
limitations of matter (previous uterine scar tissue), letting nature take its
course (natural childbirth) is still the way to go!
Routine Induction not Warranted.
Most postdate babies are not postmature. “Women have been subjected to
the hazards and emotional hardships of an induced labor without apparent
benefit.” Except when done between six and 12 weeks menstrual age, ultrasound
dating has a margin of error greater than dating by LMP. Primiparous
women average longer pregnancies than multiparas, and the average gestational
length is longer than 280 days. All clinical dating methods, including
the LMP, have margins of error of more than two weeks. Comparing the LMP
to ovulation dates from basal body-temperature records, one study found
that 70% of pregnancies classified as postdates were misclassified. Another
found the proportion of pregnancies classified as postdates by the LMP
was 15.5% versus 4.5% by ovulation date. Only two of 110 babies were postmature,
and one was not postdate. One day should be added for everyday
the cycle exceeds 28 days.
We have no accurate way to identify postdate fetuses at risk. Fetal movement
counts are not sensitive enough. Neither hormonal assays nor placental
grading are reliable. The incidence of meconium-stained fluid increases
abruptly at 38 weeks, but this relates to maturing reflexes, not distress.
Oligohydramnios associates with growth retardation, thick meconium,
and fetal distress and may have value [but false-positive rates are high].
The CST appears to have a lower false-negative rate than the NST, but
this is based on nonrandomized studies. Several studies have shown nipple
stimulation to be as safe and reliable as an oxytocin drip for the CSYT as
well as cheaper, easier, and faster. The biophysical profile accurately predicts
fetal distress at extreme ends of its scale. [What about midrange scores?]
Two studies found no increase in abnormal FHR with postdatism.
Studies of management have not found that tests accurately identify
postmature babies or that routine induction improves perinatal outcome.
Epidemiologic studies have found that much of the excess perinatal mortality
in the postdate population is due to outer factors: congenital anomalies,
infection, or IUGR. The postmature infant is relatively rare. About 10% of
pregnancies are postdates, of which 5% to 26% result in postmature babies.
Nichols CW. Postdate pregnancy. Part I. A literature review. J Nurse-Midwif 1985a; 30(4): 222-239.
—From Henci Goer’s book, Obstetric Myths Versus Research Realities: A Guide to the Medical
Literature, Bergin & Garvey, 1995
