Childbirth. What place does birth have on a pseudo-homesteading blog? Lots. When you’re talking homegrown life, DIY, natural living and health… birth has a place in all of these discussions.
You may remember that I have written about birth issues in the past, like the advantages of a home birth and what a doula does, for example. In fact, I used to have an entire blog dedicated to the topic of birth simply because I needed an outlet for all of my birthy nerdiness. Rest assured, even though I have expanded my blogging topics to cover our efforts to live a more “homegrown” lifestyle, I have no intention of abandoning the topics of birth and babies.
Before we go on, you should know that I am not a medical professional and none of the content of this blog should be taken as medical advice. The content found here should only be used as a starting point for your own research and conversation with your health care professional. Always discuss any health care decisions with your care provider- not on what you read on the internet. 🙂
As it’s approaching holiday time, I am once again hearing talk of induction requests for the purpose of having babies home by Christmas to celebrate with family- or to have a baby before the new year in order to have a tax break! Let’s not forget that voluntarily picking your baby’s birth date can be appealing at any time of year for a variety of reasons. And so we face a controversial topic- is it okay to induce labor merely for schedule’s or convenience’s sake?
Let’s be entirely clear. We’re not discussing induction for medical issues, like pre-eclampsia or gestational diabetes. We’re not talking about induction for a postdates pregnancy (42 weeks and later). We’re talking about an induction simply because the mother or care provider has desire to have the baby at a particular time without any medical indications for the need to do so- something known as an elective induction.
Some say it’s no big deal to induce a full term woman if she’s at no apparent medical risk for doing so. Others say you should never induce unless it’s medically necessary. The thing about induction is that there are several different methods and each has it’s pros and cons. What are these methods?
1) Ripening the cervix. Commonly, doctors will administer a prostaglandin gel or a tampon-like insert to the cervix to help it soften, thin, and get ready to dilate. Sometimes doctors will use a drug called Misoprostol, which is a more controversial ripening method, though cheaper to use and generally more effective. These ripening methods help to make the cervix more favorable for labor and/or other induction methods. A less common artificial ripening method is use of the foley catheter (basically a mini-balloon that inflates inside your cervix). If your cervix isn’t ready, more invasive induction methods aren’t likely to be successful.
2) Pitocin (or oxytocin) usage. If your cervix is favorable (nice and soft and thin), your care provider may start you on a pitocin drip through an IV. While pitocin is rather effective in increasing the frequency, strength, and duration of contractions, it is also generally agreed upon as more painful than a natural labor. Along with pitocin comes the increased risk of the need for pain medication, fetal distress, cesarean section, and/or adverse effects on newborns. You will need a continuous IV and continuous monitoring if you receive pitocin.
3) Amniotomy, or artificially breaking the waters. While some swear that breaking the amniotic sac will successfully bring on contractions, others argue that it is a gamble and may or may not actually start or strengthen labor. According to this study, amniotomy does not significantly reduce the length of first stage labor- it only shortens it by about 20 minutes! What’s more, it carries with it increased risk of infection, the possibility of encouraging poor fetal positioning, and a slightly (though not statistically significant) increased risk of cesarean section.
4) Natural Induction Methods. There are many folk methods for inducing labor- everything from a bumpy car ride to eating pineapple. Slightly more valid options include acupressure, castor oil, evening primrose oil, and herbal and homeopathic remedies. But hands down, the best methods for cervical ripening and (perhaps) beginning labor are sexual intercourse and nipple stimulation. These last two promote the same hormones (prostaglandins in semen, oxytocin release in both activities, etc.) that stimulate labor naturally or through artificial induction.
Now, the point here is not SO much whether or not these methods will work for you- because labor progress is a complicated thing!- but whether or not you should consider one of these methods for an elective induction.
Here’s what you need to know about induction: it can carry with it a variety of risks to both mother and baby. An early elective induction (before 39 weeks) can increase the risk of lung, brain, and liver problems, and low birth weight in your infant. ACOG says that restricting the use of elective inductions can reduce the number of c-sections. ACOG also states that suspecting a big baby is not an acceptable reason for early induction.
For the sake of full disclosure, I am generally not in favor of elective inductions without a medical indication. But- here’s the thing- if you are full term and/or post dates, have a favorable cervix, and a really strong reason why you want this baby now, and you have access to a less-invasive method of induction, it’s possible that an elective induction may be a relatively safe choice for you.
For example, I chose to try to get my labor for V moving by having my midwife strip my membranes and taking an herbal concoction. Why? I was already 5 cm dilated, not in active labor, and I live 30 minutes from the nearest hospital and 1 hour from my midwife. For me, this was about avoiding an accidentally unassisted home birth due to a precipitous (really fast) labor. While I still would have preferred going into full-blown labor on my own, I felt safe about my choice to self-induce. (While not a medical indication per say, it was not a choice made for convenience either.)
However, you must be aware that more intense methods of self inductions (like an amniotomy or a strong increase in pitocin drip, for example) introduce a higher level of risk that would not be present by waiting for labor to begin on its own. This does not necessarily make the choice wrong, but it is one that you must consider carefully.
The bottom line? Generally, the evidence suggests that its best to avoid an induction unless you have a medical indication for one.
Think twice before inducing your labor to have your baby home by Christmas. Talk with your doctor or midwife about the pros and cons. Is there a very important reason that you need your baby born on a certain date? Is your cervix favorable? Are you at least 39 weeks pregnant, and preferably more? What are the possible risks and benefits for you and for your baby? Would it hurt you to wait a little longer?
These are questions that only you and your care provider can answer. Hopefully, if you are armed with good information, clear options, and an open discussion, you can make a well-informed, healthy decision for you and your new baby.