When is this baby coming out? Will I be able to find someone to take care of my older children when I go into labor? How do I get to the hospital if I go into labor when no one else is around? Should I plan to be in the hospital over Shabbat? Should I just ask my doctor to induce labor so that I can plan everything in advance?
Expecting a baby’s birth is exciting but nerve-racking for many families. Some moms and dads love the element of surprise while others are overwhelmed by all the unknowns. Will the baby be born in the middle of the night? What will happen if Dad is at work? What if I go into labor during Shabbat? The unpredictability of birth makes some moms wonder, “Should I simply ask my doctor to induce my labor?”
Arranging for a planned labor induction can allow the birth to occur at a more convenient and predictable time, as well providing time for all the necessary pre-birth preparations. This is an option that some parents now consider. Some parents are offered the option of having their doctor artificially stimulate the labor on a specific date after the pregnancy has reached full term.
This is called “elective labor induction,” because the procedure is electively chosen in an uncomplicated pregnancy, as opposed to being done on an emergency basis. Some methods of induction include the premature rupturing of membranes, other methods use medications or even herbs.
Inducing labor is not new. Doctors have used artificial labor induction techniques of various sorts for many centuries. The earliest methods used membrane rupture, mammary stimulation and devices to stretch open the cervix. It wasn’t until the 20th century that doctors began to use medications or hormones to induce labor.
Historically, however, the induction of labor was done when the mother’s or baby’s health was at risk. For example, induction might occur if the mom’s blood pressure became dangerously high or if the baby was in distress. The more recent trend of elective induction of labor has been used for the sake of convenience, instead of medical necessity. The question then becomes: Should we? More specifically: Is it safe?
A team of obstetrician doctors and midwives in Australia recently researched the safety of this practice (1). They looked at the safety of elective inductions for both the mother and the baby. It was a large study that compared safety amongst 28,626 women broken up into three groups: 1) those who underwent childbirth after a normal, spontaneous labor; 2) induced labor for medical reasons; or 3) electively induced labor. All women in this study gave birth after a full term pregnancy (37 weeks pregnant or more).
The researchers watched for many different types of complications, such as needing a cesarean section surgery, serious bleeding after the birth, infections, large perineal tears, birth injuries, death, the baby needing assorted types of treatments and several others factors.
Overall, the study showed that elective induction of labor was linked to a 55% increased risk of labor complications compared to women who went into labor spontaneously. There was a 67% increased risk of needing an emergency cesarean section surgery for women who had an elective induction.
As a group, women who were induced for any reason were more likely to need an epidural or spinal pain medicine. Women who were specifically induced on an elective basis were at a 45% higher risk for needing these pain injections compared to women who went into labor without artificial induction.
This raises the question of whether it is a worthwhile trade-off to have the convenience of a pre-scheduled birth in exchange for increased risks to the mother’s health.
The research team also found increased risks for the baby when the mother was electively induced. Babies from an electively induced labor were 64% more likely to need level 2 nursery care (a higher level of care) and 44% more likely to need treatment, compared to babies born after a normal onset of labor. This means that mothers who are willing to risk some complications for themselves still must consider the effect on their soon-to-be-born baby.
The researchers noted that their findings agreed with several other studies that showed increased risks for both mom and baby following elective labor induction. The fact that the timing of the birth may be more predictable may not be such a worthwhile trade-off. In fact, the unpredictability of the timing of the birth is being switched with the unpredictability of the complications. Many of these complications also require a longer hospital stay, nullifying the gains. Still, for some expectant parents, elective induction is the right choice. This becomes a complex decision that requires discussion and thought. In the meantime, b’sha’ah tovah - in good time!
(1) The study was published in February 2012 by Dr. Rosalie M. Grivell at the University of Adelaide in Australia.
Ariel Siegel has been a licensed Physician Assistant (PA) for over 10 years, a 16 year veteran of the 911 and Hatzalah emergency medical systems as an EMT and Paramedic, and a medical writer/editor. All rights reserved. Please do not reprint without written permission. Contact: email@example.com.