The Induction Talk

You’re perhaps 39 or even 40 weeks pregnant and planning a natural birth. Then, your doctor wants to have The Induction Talk. If this wasn’t part of your plan and you feel uneasy about this option at this time, here are a few ideas to consider as you prepare for this discussion.

When your care provider suggests any drug, test or procedure, use your BRAIN. That is, ask: What are the Benefits? What are the Risks? What are the Alternatives? Listen to your Instinct. And consider what would happen if you did Nothing at this time because you want to let Nature take her course or because you Need more time to research or get a second opinion? More on using your BRAIN here.

Remember that most spontaneous labors start at 41 weeks and 1 day. If you and baby are healthy, there’s really no need to rush. It is well within the norm to give birth between 40 and 42 weeks.

Question the reason for induction. If everyone you know has been induced by that doctor on a Sunday night so they could have their babies on Monday, that is a Huge Red Flag.

Sounds crazy, right? It happens. Don’t induce for another person’s convenience.

Is it because of a “large baby”? Then read this.

The bottom line? In summary, for non-diabetic moms:

  • Ultrasounds and care providers are equally inaccurate at predicting whether or not a baby will be big. If an ultrasound or a care provider predicts a big baby, they will be wrong half the time.
  •  If a care provider thinks that you are going to have a big baby, this thought is more harmful than the actual big baby itself.
    • The suspicion of a big baby leads many care providers to manage a woman’s care in a way that triples her risk of C-section and quadruples the risk of complications.
    • Because of this “suspicion problem,” ultrasounds to estimate a baby’s weight probably do more harm than good in most women.
  •  Induction for big baby does not lower the risk of shoulder dystocia and may increase the risk of C-section, especially in first-time moms.

Is it due to low amniotic fluid? Then read this.

There is no evidence that inducing labor for isolated oligohydramnios at term has any beneficial impact on mother or infant outcomes. Based on the lack of evidence, any recommendation for induction for isolated oligohydramnios at term would be a weak recommendation based on clinical opinion alone.

In summary, this is what I found about low amniotic fluid in an uncomplicated pregnancy at term (37-42 weeks):

  • Ultrasound measurement is a poor predictor of actual amniotic fluid volume
  • The single deepest pocket method of measurement has fewer risks than the AFI
  • Poor outcomes seen with low amniotic fluid are usually due to underlying complications such as pre-eclampsia, birth defects, or fetal growth restriction
  • The main risk of low amniotic fluid at term in a healthy pregnancy is induction (and Cesarean delivery as a result of the induction) and potentially the risk of lower birth weight
  • Current evidence does not support induction for isolated oligohydramnios at term.

Meanwhile, be proactive with your more natural induction methods: walking, sex, nipple stimulation, acupuncture, red raspberry leaf tea, chiropractic and so on. Let your doctor know that you are proactively working to help prepare your body and baby for birthing.

Try to relax! Connect with your baby, visualize your positive birth experience. Toss stress and anxiety aside.

Ask your doctor detailed questions about the suggested induction method:

What exactly happens in an induction? Walk me through the process.

Do you use pitocin? Cervidil? Cytotec? How do these affect my ability to:

  • Walk around?
  • Drink fluids? Eat popsicles?
  • Not have an IV?
  • Get time off the fetal monitor?
  • Get in the birthing tub?
  • Move off of the bed? Use a birth ball? Get on hands and knees?
  • Can I still go to the toilet or would I need a catheter?
  • Do common side effects include blood pressure changes? What else?
  • How is baby affected?

What are your care provider’s statistics for unmedicated vaginal births after induction? How many inductions lead to epidural births? Cesareans?

Ask these questions now so you will be well prepared for the consequences of induction, if that is your choice.

Be prepared to negotiate. If your doctor wants to schedule induction for 40 weeks 3 days, but you feel rushed and prefer giving baby more time, suggest that you’d like to try a number of methods listed above first and if baby doesn’t appear by 41 weeks and 5 days (for example only – you need to choose what time frame feels right to you!), then perhaps you’d be willing to induce. Take an active role in your care!

At the end of the day, you chose your care provider for a reason. Hopefully there’s an element of trust and respect there. Be open-minded. You can be gentle but firm in expressing your willingness or unwillingness to do something. Recognize that to have a positive experience, you may have to compromise on a few things. Bear in mind too the fact that a number of policies and procedures are not determined by your doctor but by the attorneys, insurance companies and administrators who have never set foot in the labor and delivery units. If you are adamant that you do not want an IV, perhaps a hep lock would be a good compromise. Work with your provider and if it really does not go well, consider finding one who is more aligned with your philosophy. I’ve never had a client make a late decision to switch and regret it.

Remember, this is your body and your baby and you need to make the decisions that are right for you. Own your choices.

Your doctor will not have sleepless nights about your birthing choices, and s/he probably attends many births each week. You, on the other hand, will never forget this birthing experience. Now is the time to start advocating for yourself. As a patient, you have rights, including the rights to informed consent and informed refusal.

 

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