Inducing Labor at Full Term May Have Benefits

[cilantro]

Just thought I'd throw this one in here for discussion...

well.blogs.nytimes.com/2015/04/23/inducing-labor-at-full-term-may-have-benefits/

Inducing Labor at Full Term May Have Benefits

By NICHOLAS BAKALAR APRIL 23, 2015 5:40 AM April 23, 2015 5:40 am Comment




Inducing labor in normal full-term pregnancies has generally been frowned upon, but a new study suggests that induction causes no apparent harm, and may have advantages.



Researchers pooled data from five randomized trials involving 884 women with uncomplicated full-term singleton deliveries at 39 to 41 weeks’ gestation. Half had induced labor, and half got regular care. The analysis appears in the American Journal of Obstetrics & Gynecology.



Previous observational studies have concluded that induction leads to more cesarean sections, but the data from these trials produced no evidence of this. Nor was there any difference between the groups in five-minute Apgar scores lower than seven (scores below seven call for medical attention) or admission to a neonatal intensive care unit.



Particularly, they found that induction was associated with significantly lower blood loss for the mother and a significantly lower rate of meconium staining, a fetal bowel movement in the uterus that can cause serious respiratory problems for the infant.



“We have the preliminary data saying that what we thought about induction — that it led to increased C-sections — is wrong,” said the lead author, Dr. Vincenzo Berghella, a professor of obstetrics and gynecology at Thomas Jefferson University in Philadelphia.



Induction before 39 weeks in healthy pregnancies is not recommended, Dr. Berghella said, but at 39 weeks and later, “induction is safe and effective, even in cases without other complications of pregnancy.”

[kategm]

I was nervous about inductions, but my OB told me that once you hit 40 weeks the baby is done "baking" and there was no medical reason to keep them in any longer. She said that more harm than good could happen the longer they're in. This made me feel comfortable with deciding to induce at 41w

[motzie]

This is nice to hear. I felt like I got some side eyes (not here) for inducing at only 4 days over, but I was done, and I don't regret it for a second.

[cilantro]

I ended up with a c section and I frequently hear "ooooh, it's because you let them induce you." It seems to be written in stone that that's how it works. I have a feeling that no matter how many studies to the contrary come out, many won't change their minds. It's part of the "OBs are evil, just want to give you a c section and get home to dinner" line that everyone's swallowed.

[Brie]

I'm pretty sure there's a huge benefit to a mom-to-be's mental health not having to be hugely overdue.

[marina007]

I love reading this - very reassuring.

[kategm]

Also, my mom never went into labor with my sister. She was a month overdue. A MONTH. They did a c-section and my sister spent a week in the NICU because her lungs were overdeveloped and she was swallowing fluids. Bad things can happen if they bake too long.

[speyedr]

I had one at 39 weeks that went as planned. 11 hours from start of pitocin to delivery. DD had apgars of 8 and 9 (10 is rare because of the altitude here). She was a healthy 8lbs 5oz and had no issues. As long as my Bishop score is favorable this pregnancy at 39 weeks I will induce again.

[Marmee]

I had 4 inductions...no regrets. . I'm fairly certain I'd have had giagantic babies if I waited...lol. DD3 I waited longest (39wks 3days) & she was almost 9lbs.

[marina007]

Apr 23, 2015 12:40:01 GMT -5 kategm said:

Also, my mom never went into labor with my sister. She was a month overdue. A MONTH. They did a c-section and my sister spent a week in the NICU because her lungs were overdeveloped and she was swallowing fluids. Bad things can happen if they bake too long.

OMG!!! I didn't even know this was possible!

[charlotteandwilbur]

This is just the article I needed to read right now, my doc is pushing heavily for induction. Thanks.

[soxin2]

I had two pitocin inductions at 41w5d and 41w3d.

[Velar Fricative]

Apr 23, 2015 12:56:25 GMT -5 marina007 said:

Apr 23, 2015 12:40:01 GMT -5 kategm said:

Also, my mom never went into labor with my sister. She was a month overdue. A MONTH. They did a c-section and my sister spent a week in the NICU because her lungs were overdeveloped and she was swallowing fluids. Bad things can happen if they bake too long.

OMG!!! I didn't even know this was possible!

I feel like everyone in my mom's generation was a month overdue lol. Or at least every woman of my mother's generation that I've talked to about these things. I thought it was because the dating u/s technology wasn't as great back then.

I often wonder what would have happened if I didn't get induced at 41w3d (DD was born at 41w5d). She was too damn comfortable in there and literally nothing was happening before then (no contractions at all during pregnancy, no dropping, no anything). In hindsight, I don't think she would have made it out on her own by 42w either but I'll never know. She was only 7 lbs 7 oz despite me being very certain about my dates and being born to two non-petite parents who were both big babies. I do hope to experience a spontaneous labor this time around but I'm not betting on it thanks to my comfortable womb. 

I did/will deliver at a hospital with very strict policies on inductions and they do credit this with them having the lowest c-section rate in all of New York City (~19% for primary births in 2013, the year I had DD). I always assumed the induction policy was the main reason why so I am interested in seeing further studies if they end up refuting this.

[water*drop]

Apr 23, 2015 12:58:53 GMT -5 charlotteandwilbur said:

This is just the article I needed to read right now, my doc is pushing heavily for induction. Thanks.

If you want to read another reassuring article, the slightly older paper that's summarized here had similar findings: blogs.scientificamerican.com/absolutely-maybe/2014/09/08/long-overdue-is-the-question-of-induction-of-labor-and-cesarean-section-settled/

[anna7602]

My post-partum hemorrhage was directly related to the amount of Pitocin I received during my induction. I'm not going to change my mind any time soon about whether my induction was really that beneficial. I mean yes, I ended up with a baby, but I think I could have gone into labor in my own and ended up with my baby as well.

[InBetweenDays]

Apr 23, 2015 13:12:27 GMT -5 Velar Fricative said:

Apr 23, 2015 12:56:25 GMT -5 marina007 said:

OMG!!! I didn't even know this was possible!

I feel like everyone in my mom's generation was a month overdue lol. Or at least every woman of my mother's generation that I've talked to about these things. I thought it was because the dating u/s technology wasn't as great back then.

I often wonder what would have happened if I didn't get induced at 41w3d (DD was born at 41w5d). She was too damn comfortable in there and literally nothing was happening before then (no contractions at all during pregnancy, no dropping, no anything). In hindsight, I don't think she would have made it out on her own by 42w either but I'll never know. She was only 7 lbs 7 oz despite me being very certain about my dates and being born to two non-petite parents who were both big babies. I do hope to experience a spontaneous labor this time around but I'm not betting on it thanks to my comfortable womb. 

I did/will deliver at a hospital with very strict policies on inductions and they do credit this with them having the lowest c-section rate in all of New York City (~19% for primary births in 2013, the year I had DD). I always assumed the induction policy was the main reason why so I am interested in seeing further studies if they end up refuting this.

I had a very similar experience - absolutely no progress at 41w3d. My doctor said she couldn't even reach my cervix to try and sweep my membranes. So I ended up with a Pitocin induction and DD was 6lbs 10oz at 11 days overdue.

I also had high hopes for going on my own with #2, but went to 41w2d before getting a Cervidil induction (put me into labor so I didn't need Pitocin).

[anna7602]

Interesting that I'm the only person in this thread so far who regrets her induction. The whole thing, from the 22 hours in labor, to the additional 24 when I was practically immobile and being treatedfor my pp hemorrhage, were awful.

[Velar Fricative]

Apr 23, 2015 13:29:58 GMT -5 anna7602 said:

Interesting that I'm the only person in this thread so far who regrets her induction. The whole thing, from the 22 hours in labor, to the additional 24 when I was practically immobile and being treatedfor my pp hemorrhage, were awful.

I did not love my induction and absolutely wish DD would have just come out on her own. But it's hard to actually regret the induction given that I only had a few days left before I would have had to have no choice but to be induced anyway. And I did not experience any complications afterwards or else I would be singing a different tune.

[ilikedonuts]

I was induced at 40w1d both times. My inductions were both a breeze. No regrets.

ETA: I only had pitocin with DD2. With DD1, all I needed was cervadil for like 4 hours before it fell out.

[laurack]

I didn't love my induction, mainly because the contractions were so painful from pitocin, and having to cart the IV around was annoying. but I was 42 weeks and beginning to worry. She was fine, but my sons birth (not an induction) was more pleasant for me.

[rootbeerfloat]

Apr 23, 2015 13:29:58 GMT -5 anna7602 said:

Interesting that I'm the only person in this thread so far who regrets her induction. The whole thing, from the 22 hours in labor, to the additional 24 when I was practically immobile and being treatedfor my pp hemorrhage, were awful.

My induction sucked. I vastly preferred my scheduled c/s. But with the induction, at least I can say I tried, right?

[penguingrrl]

I had three good inductions, but mine weren't elective. I had high blood pressure and increasing protein in the urine, so my choices were induction or immediate C because I had to deliver immediately. I had the first result in a very unnecessary C due to an impatient OB, but the other two resulted in safe VBACs, so I was generally pleased with them.

[ringstrue]

Ugh. I get what they are saying, but nothing happens at 40 weeks to make a baby "done baking." Yes, ITA that approaching 42 weeks is when everyone should start thinking induction especially when the EDD is really accurate, but not inducing before then isn't bad, either, or dangerous.

Induce if you want, or don't. I don't care. But be accurate with information. And realize that everyone's situation is different and a good doctor's care is the real goal.

[anna7602]

Apr 23, 2015 15:24:36 GMT -5 @vicmo said:

Apr 23, 2015 13:29:58 GMT -5 anna7602 said:

Interesting that I'm the only person in this thread so far who regrets her induction. The whole thing, from the 22 hours in labor, to the additional 24 when I was practically immobile and being treatedfor my pp hemorrhage, were awful.

I keep thinking about this. I would guess (no research to support) that most inductions aren't really elective and therefore I think regret is an unusual emotion to have. I mean, they are elective in terms of the exact day, but when you get to 40, 41, 42 weeks pregnant, there are few options if you haven't gone into labour on your own. So I have regret that my body didn't kick itself into labour, but given that it didn't, should I regret my induction? Should I wish that I'd been given a few more days to do it on my own?

Mine was not elective, but yes, I wish I'd been given a few more days to do it on my own. I'm sure there are lots of c-section moms who wish they'd been able to deliver vaginally or who wonder if a different doctor might not have been as zealous about proceeding with a section, so it doesn't feel like I'm that unusual for being less than thrilled with the circumstances leading to my son's eviction from my womb.

Eta: maybe "regret" isn't the best word in my case. Absolutely hated is more appropriate. But, I do know women who, while nt having the choice exactly to deliver on their own before 40 weeks, were given a choice by the doctors to induce at 40w v 40w, 3 days v. 41w, etc.

[docholly]

I was induced at 41 weeks and 40 +5. I had a long induction with ODS because he was sunny side up, but other than that, it went well. My second induction was a breeze.

I don't know if they are medically beneficial until 41 weeks (when my OB makes you have them), but I certainly don't bat an idea when someone chooses to have one at any time after 39 weeks.

[madisen]

With my 2nd, I was electively induced at 39 weeks 1 day. I didn't have any medical reasons for it but I asked about it and my drs were ok with it. I went in at 6:30am, got pitocin and had my water broken, got my epidural around 10am, and dd was born at 1:45pm.

It was a decision between my drs and me and I was fortunate to have an easy l&d with no complications for dd or me.

[Marmee]

I will say all mine except technically DD1 were medically indicated. I had the same condition with DD1 but it was not diagnosed because it's rare & my OB did not pursue my symptoms. I was sooo (beyond normal, I was in hell) miserable though so that played into my not hesitating at all on going forward with her even though it wasn't medically indicated. I had them at 37.5wks, 38.5wks, 39.5wks & 37wks. DD4 was maybe a little too early (but again with my condition, 37wks is now the recommendation) but all the rest were fine. My "late" baby at 39.5wks by far had the most issues healthwise & her size did damage to my body that none of the others did. I can only imagine how a bigger baby would have impacted me..lol. My actual labors & deliveries luckily were non-eventful.

[savan]

I had 2 inductions due to very high blood pressure. One was 38.5 weeks so not full term but the other was just hours before 40 weeks. Both went very smoothly with no complications. With DD they started pitocin at 7:30 and she was in my arms at 10:53. I'm convinced I would have given birth on the bathroom floor if I'd gone on my own.

[Shreddingbetty]

Apr 23, 2015 13:22:52 GMT -5 anna7602 said:

My post-partum hemorrhage was directly related to the amount of Pitocin I received during my induction. I'm not going to change my mind any time soon about whether my induction was really that beneficial. I mean yes, I ended up with a baby, but I think I could have gone into labor in my own and ended up with my baby as well.

I had an elective induction at 38.5 weeks. I only got cytotec and never needed pitocin. I still got a severe PP hemorrhage 11 days later (but it was due to retained products of conception aka placental remnants). Cytotec is also used to treat and prevent PP Hemorrhage....go figure. 

I don't  regret mine at all and had a good experience. My water broke at 5 and and Dd was born at 8 after pushing 3 times. I might feel differently if it had gone on for hours and hours. My OB didn't expect me to go until the pm and was in surgery that morning so she couldn't deliver me and I was bummed about that. The OB that delivered me delivered her own kid just 5 days later and our kids are friends and in school and soccer together. She was totally fine and I had no complaints about her but at that time I didn't know her really and was bummed my OB couldn't do it. I sort of assumed that since I was being induced that the chances of my OB doing the delivery would be good since it was somewhat controlled. Teaches me to go fast! (But thankful for that)

One of my friends in the Netherlands had first kid a good 3 weeks late. They were going to do a c action at 41 weeks because she was breech but then baby turned and they canceled. She ended up with an emergency c section at 43 weeks and barely had any amniotic fluid left. With the second one she was begging for an induction   but they wouldn't do it. Things turned out Ok but she was scared especially the second time around. They finally agreed to a c section at 41 weeks with the second There is such a thing as baking too long. But in the Netherlands they are more hands off I guess to let things progress naturally. Nothing wrong with that but you can take that too far too. 

[MrsAggie]

I'm glad there's articles out there educating this. I feel like the hate on inductions, etc. are just an early version of mom-shaming.