HWN Suggests

Are Fears of Inducing Labor Overblown?

Few subjects provoke as much uncertainty among expecting parents as the practice of induced labor. Until 2018, the American College of Obstetricians and Gynecologists advised doctors that, unless mother and fetus were in distress, they shouldn’t induce labor until a pregnancy reached 41 weeks (39 weeks is considered full-term). At that point, they said, the risks of health complications for mom (like high blood pressure) and for baby (like brain injury or breathing problems) could rise. But, the thinking went, inducing before 41 weeks could increase the likelihood of a C-section. “Ten years ago, the entirety of my training we were taught that induction increases the chances of cesarean...

read full article

Featured

 Ten things I wish every woman knew about induction of labour

nduction is really common now. Some people think it’s oversold. It’s often not discussed in depth, and women are sometimes given an induction date without even being asked whether this is what they want. Many of my colleagues and a lot of the people who read my books are concerned about how a lot of the ‘official’ information is geared to promoting induction. Women and families are often told the pros of induction, for instance, but the downsides aren’t mentioned. And this isn’t accurate. In reality, there are pros and cons to everything. And there are many other aspects to the decision that some women need to consider about whether or not to have their labour medically induced.

 Trying To Induce Labor? Read This First

What to know before you chug that castor oil.

 Was the ARRIVE labor induction trial wrong?

Over the last 30 years, labor induction rates have tripled [1]. Why have they risen so rapidly, and has this increase been for the betterment of fetal and maternal health? In 2018, the ARRIVE trial seemed to suggest that labor induction for low-risk, first-time mothers at 39 weeks gestation was safer than waiting for labor to start on its own. But a 2024 study from Victoria, Australia published in the journal Birth Issues In Perinatal Care calls the ARRIVE trial’s findings into question

Articles of Interest

Does Anything Actually Make You Go Into Labor?

Most of the popular legends are more myth than fact, but there are a couple of interesting exceptions.

Exploring induced labor for full-term pregnancy

A large study found that, for healthy women, inducing labor at full term rather than waiting for natural labor doesn’t increase the risk of major complications for newborns. The findings also reverse the notion that inducing labor at full term increases the risk of needing surgical delivery.

Inducing labor at full term: What makes sense?

This multicenter, randomized, controlled trial involving thousands of women compared outcomes of induced labor versus "expectant management" — just waiting for labor to begin. All participants in the study were expecting their first baby, and all were within one week of their due date. For most of the women, their cervix wasn't really open yet. No special methods were used to induce labor, just what was standard at each institution. The results were interesting. For the baby, similar numbers of complications and need for intensive care occurred in both groups. However, when compared with waiting for labor, induction decreased the likelihood that the baby would need help with breathing. Breastfeeding success was no different between the two groups. The big news? Inducing labor was associated with a lower rate of cesarean delivery (approximately 19% versus 22%).

Inducing Labor Pros and Cons

From a purely medical perspective, an induction at or close to the due date is NOT considered medically necessary. However, there may be some physical or emotional benefits to labor induction at term. Weight gain, back pain, varicose veins, and sleep problems all increase as pregnancy progresses. Labor induction and birth put an end to the discomforts of pregnancy. In fact, 19% of women ask for inductions because they would like to be done with their pregnancy.

Induction of labor: the misoprostol controversy

Induction of labor is a common obstetric procedure, and approximately one-fourth of pregnant patients undergo the procedure. Although exercise and nipple stimulation can increase the likelihood of spontaneous labor, sexual intercourse may not be effective. Acupuncture has been used for labor induction; however, it has not been shown to increase vaginal delivery rates. There is strong evidence that membrane sweeping can increase the likelihood of spontaneous labor within 48 hours. Cervical preparation or ripening is often needed before induction.

Mechanical methods for induction of labour

Mechanical methods were the first methods developed to ripen the cervix and induce labour. During recent decades they have been substituted by pharmacological methods. Potential advantages of mechanical methods, compared with pharmacological methods may include reduction in side effects that could improve neonatal outcomes.

Pregnancy Debate Revisited: To Induce Labor, Or Not?

Obstetricians currently induce labor when a delivery has failed to progress, or if a woman is far overdue for giving birth. But when women who have no medical need for induced labor have talked to their doctors...

Recent advances in the induction of labor

Induction of labor (IOL) is certainly one of the most frequently performed obstetric procedures in the world: recent data indicate a percentage of induction of up to 35.5% in Sri Lanka 1, 24.5% in the United States 2, and from 6.8 to 33% in Europe 3. In spite of the extreme diffusion of the procedure, there are still numerous unanswered questions, or questions that have not obtained a unanimous consensus in the scientific literature.

The ethics of induction of labor at 39 weeks in low-risk nulliparas in research and clinical practice

The “A Randomized Trial of Induction Versus Expectant Management” trial (ARRIVE trial) published in 2018 suggested that induction of labor can be considered a “reasonable option” for low-risk nulliparous women at ≥39 weeks of gestation. The study results led some professional societies to endorse the option for elective induction of labor at 39 weeks of gestation in low-risk nulliparas, and this has begun to change obstetrical practice. T

The most common ways to induce labour are...

Membrane sweeping, also called a ‘stretch and sweep’ – is a procedure which happens during a vaginal examination. The maternity care provider feels for the amniotic sac or membranes and gently moves the membranes around the baby from the wall of the uterus. Breaking the waters. This is also called artificial rupture of the membranes or an ‘ARM’. Having an ARM and an intravenous drip which contains oxytocin – an artificial hormone which starts the uterus contracting. Prostaglandins – these are contained in a gel which helps the cervix to dilate. A balloon catheter – this is positioned inside the cervix and the balloon is inflated with saline/water.

What is induction of labour?

Induction is considered when there are complications of pregnancy which means there is risk to the mother or baby’s wellbeing in continuing the pregnancy. The most common indications include high blood pressure (including preeclampsia), PUPPPS, diabetes, cholestatic jaundice of pregnancy, postdates pregnancy, intrauterine foetal growth retardation, unstable foetal lie, twins, a history of a previous very rapid labour, planned VBAC going overdue and to avoid a baby getting too big for an uncomplicated vaginal birth, foetal demise. Sometimes induction is done because of maternal request such as family commitments, husband/partner work commitments, to time arrival of relatives from overseas, excessive pregnancy discomfort, etc.

Resources

Too many healthy women are having their labour induced for no identified medical reason, our study shows

Our research found sometimes inductions are done where there is no identified medical reason. As previous research has shown, this is especially the case in private hospitals. Sometimes women are told their baby is bigger or smaller than normal. Bigger babies may lead to more complications with the birth, and smaller babies may not be growing well. However, ultrasound can be very inaccurate, and babies thought to be small or large are often a very average size at birth.