1. My girlfriends told me that having labor induced is the safest, and certainly most convenient, way to have my baby, but my nurse is saying that waiting for labor to start on its own is the safest. Which is true?

Many people don’t realize that undergoing labor induction for any reason is associated with immediate and long-term health risks. Induced labor can lead to excessive postpartum bleeding (or hemorrhage), which in turn, can increase the risk for blood transfusion, longer hospital stays, hysterectomy, more hospital re-admissions and, in the worst cases, death. Induction is also associated with an increased risk for cesarean birth. Cesareans increase a woman’s  risk for infection, problems with how the placenta implants in future pregnancies, and life-long pain from abdominal adhesions.

AWHONN recommends against inducing labor at any time during pregnancy unless it is medically necessary, because a woman or her baby have problems. The medication used to induce labor is a manufactured hormone and a type of drug that bears an increased risk for causing serious patient harm when used in error. With the increasing use of labor induction and its resulting complications, it’s more apparent than ever that we must improve our understanding of the health consequences of administering artificial hormones, especially to vulnerable populations like pregnant women and infants. The short- and long-term health risks are just too serious to undergo labor induction when there is not  a medical need.

2. Is it true that inducing labor does not pose any risks for a baby?

Babies face their own set of risks from labor induction, including increased fetal stress and respiratory illness, especially before 40 weeks. These issues can force a baby to be separated from his or her mother, interrupt mother/baby bonding, and result in less or no breastfeeding, which in turn increases a baby’s lifetime risks for childhood obesity and chronic illness. Worst of all, complications can mean an infant needs to be admitted to a neonatal intensive care unit, have a longer hospital stay, face more hospital re-admissions, and be separated for longer periods of time from his or her mother.

3. I’ve heard that there are no health benefits for letting labor start on its own, so why wouldn’t I want to do what is most convenient?

There are significant reasons why it’s healthier for moms and babies to complete pregnancy by waiting for labor to start on its own. Naturally occurring hormones that prepare a woman and her fetus for labor and birth typically make labor faster, easier and with less stress on the baby than an induced labor. Spontaneous labor also triggers a cascade of hormones during labor and birth that:

• provide natural pain relief, calming a woman during labor;
• help the placenta detach from the uterus;
• increase mother-baby attachment after birth;
• warm the mother’s skin at birth, which helps baby warm and hold his own body temperature;
• enhance breastfeeding;
• clear fetal lung fluid; and
• ensure that the transfer of maternal antibodies to the fetus, which makes the newborn less vulnerable to infections, has occurred prior to birth. The largest amount of these antibodies cross the placenta to the baby from 4 weeks before the estimated due date (40 completed weeks) up to 1 week after. If a woman has an induction 1 week before her due date, but would have gone into labor 1 week after had she waited, her baby will miss out on a lot of immune protection.

Additionally, researchers continue to show that a baby’s healthy development and growth benefits from a full 40 weeks of gestation. Research shows that women having their first babies, on average, will begin labor four to eight days past their due dates and women having their second or more babies will begin labor two to three days beyond their due date. Learn more about the benefits of spontaneous labor at www.GoTheFull40.com.

4. What if my labor is taking forever? Can I choose to have drugs to help stimulate contractions if I have already started labor naturally?

If labor is progressing slowly, some health care practitioners augment labor (or stimulate contractions) with the same drug used in labor inductions. While research on the risks of elective labor augmentation is limited, many of the risks associated with induction may apply because the same medication is used.

With these concerns in mind, AWHONN supports policies that limit non-medically indicated augmentation of labor and supports spontaneous labor when mother and fetus are healthy. Increasing funding for research and education about augmented labor would help improve understanding of safe labor and birthing practices.

5. I don’t understand all this concern about induced labor; women in the United States do not die of pregnancy-related causes anymore. We are more advanced than that.

Unfortunately, the number of women dying during pregnancy and childbirth continues to increase in the U.S. Two to three women die every day from complications of labor and delivery, and evidence shows about half of these deaths could be prevented. Our nation has higher death rates among birthing women than at least 46 other countries, including South Korea, and Turkey. In fact, the United States is one of the only countries where maternal deaths and injuries have increased in the last decade.

More than 50,000 women each year in the U.S.—that’s one every 10 minutes—nearly dies from a severe complication related to pregnancy or childbirth. Severe bleeding after birth, called postpartum hemorrhage (one of the risks of labor induction), is a leading cause of preventable maternal death and injury. Since investigators have demonstrated that using pharmacologic or mechanical methods to induce labor increases risks for health complications for mother and baby, AWHONN strongly recommends that women should agree to receive medications to induce labor only when there is a medical reason.

Some final thoughts from Lynn

Scheduling a baby’s birth by inducing labor with artificial hormones—rather than waiting for labor to start on its own—is now accepted as common practice. In fact, nearly 25% of U.S. births are now induced—a number that has more than doubled since 1990. Some of these inductions are needed, but others are too often performed for the convenience of busy families or obstetric providers.

What gets lost during the rush to induce labor is the fact that outside of a medical need, inducing labor can result in serious immediate and long-term medical issues for a mother and her baby. Researchers have demonstrated the potentially disastrous health consequences that can occur for women and infants with non-medically indicated inductions. Evidence shows that when a mother and baby are healthy and well in pregnancy, the mother should be encouraged, and supported, to wait for labor to start naturally—to let baby pick his or her own birthday.

Lynn Erdman is the CEO of AWHONN with more than 30 years of experience in the healthcare and nonprofit sectors. She is a highly skilled national leader in the field of nursing and previously held key national leadership positions with three global health organizations: the American Cancer Society, the American College of Surgeons, and the Susan G. Komen Global Headquarters.

For more information, please visit www.GoTheFull40.com

Also check out what our friend over at Adventures of a Labor Nurse had to say on Everything You Need to Know About Inducing Labor.