Medical Reasons to Induce
Baby isn’t moving as much. Doing baby kick counts helps you know how much your baby moves normally. If you notice your baby moving less during any given day, you should tell your doctor immediately as baby is likely not doing well and may need to come out.
Baby is in distress. This can be recognized in a non-stress test, where a machine records how your baby’s heart rate responds when you have contractions. Even if you don’t actually feel your contractions yet, practice ones are likely happening. If your baby’s heart rate doesn’t look so great, baby is likely in distress and will need to come out.
Baby is too small. Even though it’s hard for doctors to correctly measure babies by ultrasound when you’re far along in pregnancy, this one is worrisome enough to possibly warrant induction. If your baby has potentially stopped growing, something has gone wrong and baby needs to come out.
Bag of waters broke. If your bag of waters breaks and your labor hasn’t naturally started within 24 hours, you may want to agree to an induction. After 24 hours, your chances of getting an infection increase, which is dangerous for you and baby. Some doctors will want to induce before 24 hours, but you can discuss the possibility of waiting since most women have no issues waiting at least 24 hours to see if labor starts naturally.
Mom has preeclampsia. This is an extremely dangerous condition that can endanger the lives of both mom and baby. The most effective treatment is inducing labor and getting baby out.
Reasons to ask more questions if your doctor wants to induce:
Past your due date. This is one of the most common reasons for inducing. Babies are considered term anywhere between 37 and 42 weeks. Logically then, the induction discussion doesn’t even need to happen until you’re 42 weeks along. But many doctors simply schedule an induction shortly after you’ve passed the 40-week mark, and some are even proposing induction at 39 weeks (see 39-week study below). If your doctor has additional concerns, besides the fact that you’ve passed a date that was only an estimate in the first place, you’ll be able to start a discussion and learn about those concerns.
Too little amniotic fluid. This can be affected by how much water you’ve been drinking. If you’re a little dehydrated, your amniotic fluid levels may be low. If your baby is doing fine in all other ways, maybe suggest a repeat ultrasound in a couple days… and drink a good amount of water until you come back for your next ultrasound!
Baby is too big. This is pretty hard for doctors to measure by ultrasound. In many cases, their estimates are off by up to 2 pounds. Your “huge” 8-pound baby could end up being only 6 pounds! As a side note, most women, even small women, have no problem delivering 8-pound babies.
The Flawed Nature of the 39-Week Induction Study
A recent study called the ARRIVE study concluded that women were less likely to have a Cesarean section if they were induced at 39 weeks as opposed to waiting for labor to start naturally. There were numerous problems with this study.
- A group of 22,533 people were invited to participate in this study and only 6,106 of them volunteered to participate. When such a significantly large number of people refuse to participate in the study, researchers should be concerned about a selection bias. This means the results of the study may not be applicable to the population as a whole.
- The mothers in the group who waited for labor to start naturally had an unusually high rate of preeclampsia compared to the normal population of pregnant women. Preeclampsia automatically increases the likelihood of having a Cesarean section. Since there were significantly more women with preeclampsia than would normally be expected, this most likely skewed the results.
- The doctors who participated in this study were all aware they were studying early induction versus waiting for women to labor naturally with regard to the Cesarean section rate. Doctors are usually more in favor of inductions because it’s more convenient for their schedules to know when their patients will give birth. This means there may have been a bias with doctors trying harder to avoid Cesarean sections in the early induction group.
All studies prior to this study have found induction leads to more Cesarean sections than letting labor start naturally. Considering the numerous issues with this study, further studies should be done rather than widely advertising to the public that inducing early is a good idea.