Induction rates are rising and in certain cases, induction is requested rather than prescribed by the doctor. At the same time, research and study is ongoing to understand the benefits and risks of induced labour. There are common circumstances when induction is recommended but not all is being accepted as justifiable. Let’s understand more about when induction is recommended and its associated risks.
Induction is recommended when:
#1 More than 2 weeks beyond due date
This is a controversial especially when it is prescribed as a rule of thumb rather than assessing the fetus on an individual basis. The argument against a strict follow of the two-week rule is that the due date of the baby may not be accurate. Therefore, induction may lead to the risk of delivering the baby before its full maturity. On the other hand, there are risks associated with the fetus being in the womb for too long, mainly (i) fetus will be too big for vaginal delivery, (ii) placenta is unable to support the baby’s growth, and (iii) fetus may inhale fecal waste during childbirth.
#2 Water has broken without contractions
#3 Inadequate amniotic fluid
#4 Placenta abruption, where the placenta has peeled away from the uterine inner wall
#5 Uterine infection
#6 Fetus has stopped growing
#7 Medical conditions such as high blood pressure or diabetes put mother and baby at risk
Circumstances for Induction
Normal vs Induced Labour
Nature should prepare the body, in particular the cervix for baby delivery. During normal labour, the brain releases oxytocin which dilates the cervix and increases contractions. As the level of oxytocin increases, endorphins are also released to reduce the labour pain. Inducing labour aims to soften the cervix, promote contractions and artificially introduce synthetic hormones, resulting in its own set of risks and complications. Here are ten reasons to avoid an induction:
#1 Risk of premature delivery
Should the labour be induced before the baby is due, the last few weeks of critical development in the baby may be compromised. Many important processes are happening in these last few weeks, including (i) passing of antibodies to the fetus, (ii) baby’s brain and lung development and (iii) swallowing and feeding abilities for survival outside of the womb. A preterm baby therefore will not be fully developed, affecting his ability to thrive outside of the womb.
#2 Increased risk of jaundice
If induction is before the baby is due (that is, the estimated due date is not accurate), the baby may be more likely to suffer from jaundice. More severe jaundice will require hospital stay.
#3 Temperature regulation complication
A preterm baby may be lacking in fats, resulting in increased risk for temperature instability. The baby will feel cold under room temperature, which is why preterm baby is often placed in an incubator or under a heating device to keep warm.
#4 Risk of lower heart rate
The contractions in natural labour are milder at the onset, gradually increasing in intensity and frequency which helps to prepare both the fetus and the mother. Conversely, induced labour may result in unnatural contractions that are too frequent, strong and sudden. This may cause the baby to be distressed and affect his heart rate. Monitoring of the fetus is therefore important for induced labour.
#5 Increased need for epidural
Due to the contractions coming too strong and the body has not reacted naturally with the release of endorphins, it is more likely that epidurals will be required to cope with the pain during induction.
#6 Increased need for assisted delivery
Not all induced labour will be successful; there is the likelihood of requiring assisted delivery where the forceps or ventouse suction are used to move the baby out of the womb. In other cases, a c-section delivery is required and more likely if the induced labour is also the first baby.
#7 Increased risk of infection
Certain methods of induction such as sweeping of membranes, breaking water or placing a balloon catheter increase the risk of infection.
#8 Umbilical cord complication
There is increased risk of the umbilical cord slipping back into the vagina (known as umbilical cord prolapse) which may compress the umbilical cord and decrease the oxygen to the fetus.
#9 Breastfeeding complication
It is observed that for induced labour, there is a lower rate of breastfeeding success – it may be due to many reasons, such as preterm birth, the increased stress during induction, epidural or assisted delivery.
#10 Post-delivery complication
Post-delivery complication such as the inability of the uterine muscles to contract after birth can lead to excessive bleeding.
The decision to opt for induction should not be taken lightly or decided based on that it is more common these days. Both induced labour and not doing so have risks and there should be a discussion with the doctor to go through the various options and their associated risks.
