Why labor induction if everything is going well?

October 31, 2013 10:19 AM

I will be 39 weeks along tomorrow. All of my OB appointments have basically amounted to urine test, weight, blood pressure, various forms of checking stuff with the pronouncement, "EVERYTHING'S GOING SO WELL." (I imagine Ziegler from Moulin Rouge.) Which, yay. Very grateful. However, she made a surprising comment today.

Today was similar to all the other visits. The OB did an ultrasound for a biophysical profile and the baby got 100%, which warmed my type A cockles. Cervix is 3cm dilated, stretchy, the baby is forward and his head is in the pelvis.

If everything is "beautiful", though, why did she say "I wish you'd let me induce you" today? I've been straightforward with her about wanting a low-intervention birth; this comment was sort of offhand, and I didn't feel any pressure about it. But is there any medical reason for induction when everything seems so textbook? I am definitely at the stage where I get why one might acquiesce to induction, because heartburn and general discomfort, etc. I am interested in letting the labor take its course unless there is an indication for induction... then all bets are off. (Note, I'm not asking "what is the medical reason why *I* should consider induction?" My question is more why would she suggest it to me when there is no medical indication. Other than, "I want to deliver you during reasonable work hours"--I can guess that one on my own.)

I realize you are not my doctor, and I should have asked her to clarify. I was a little bit too surprised and flustered to say anything except, "no, that's not going to happen". Will be discussing with my doula tonight, but was hoping for any insight/experience from the Hive.

posted by emkelley to Health & Fitness (41 answers total)

If the baby is healthy enough and of the right size and etc. etc., doctors would rather do the delivery on their own terms. As you say, "reasonable work hours" is a thing. There's a tiiiny bit of "We don't want the baby to get any bigger," but that's more a justification of wanting it on a better schedule than "Whenever the baby decides" than any real concern.
posted by Etrigan at 10:21 AM on October 31, 2013 [9 favorites]

I am not a medical person of any kind whatsoever. However, not long ago I read an article about how inductions have become very common to save hospitals and doctors time. The kernal of the article was that if induction can be performed, why should hospitals and staff wait around for x hours of labor?

I can try to find the article if you like.
posted by michellenoel at 10:22 AM on October 31, 2013 [4 favorites]

Also, we all know that time = $$.
posted by michellenoel at 10:23 AM on October 31, 2013

Is there a weekend issue, like if you deliver spontaneously this weekend, your doctor wouldn't be the person who would be there?
posted by LobsterMitten at 10:25 AM on October 31, 2013 [5 favorites]

For more background on the controversy over whether doctors recommend induction too much, you might appreciate this recent thread.
posted by willbaude at 10:25 AM on October 31, 2013 [1 favorite]

It's also a form of defensive medicine. I don't think it raises any alarms. One of my children was induced and we were frankly delighted that we would know when we would meet our son.
posted by Tanizaki at 10:26 AM on October 31, 2013 [1 favorite]

It's also for the parents convenience if that's what they'd like.
My little brother was my mom's third child and was a c-section by necessity, but that meant she got to pick the day. Because of that, he shares a birthday with my grandma who my mom lost when she was very young.
posted by rubster at 10:32 AM on October 31, 2013

She said it for no other reason than that is what she learned once upon a time should be done. It's absurd. If there were a medical reason for you to be induced, then absolutely you should be induced. But there isn't, so don't.
posted by zizzle at 10:32 AM on October 31, 2013 [11 favorites]

Best answer: Induction leads to more intense, but faster labor--early induction (right before full term or at full term) might be thought to stem the possibility of a big baby, as well. Big babies are thought to be at a higher risk for shoulder dystocia, though induction itself carries other risks, including higher risk for C-section (and C-sections themselves carry risks, too). You doctor might think that the faster, more controlled labor of an induction feels less risky to her than the fear of something like shoulder dystocia (there's a good article on risks and management of dystocia here).

I am not a doctor. I am an expectant mother seeking a low-intervention home birth. The question itself is pretty controversial.
posted by PhoBWanKenobi at 10:33 AM on October 31, 2013 [3 favorites]

Best answer: I was thinking big baby, too. If you're full term now, a week from now the baby is going to be bigger, and thus, harder to get out.
posted by roomthreeseventeen at 10:34 AM on October 31, 2013 [1 favorite]

if i'm responsible for a dozen women in late-stage pregnancy, i would try to space them out so they don't all go off at once.
posted by bruce at 10:36 AM on October 31, 2013 [4 favorites]

Best answer: It could also be that the doctor sees a healthy baby with 3 cm dilation and wants that 'extremely high positive outcome' birth to happen now instead of the mystery that one or two weeks from now could bring. From that point of view, why put off until an uncertain tomorrow what could be done with almost complete certainty right now.

Also, doctors are like a lot of other people who work in highly-repetitive jobs. I would bet that most of her 39-week patients with good dilation are eager to get this baby out, start a new life, get rid of their back spasms and frequent bathroom visits and generally move on from something that has gotten to be a burden. The previous 127 patients felt that way, why would you be any different?
posted by BearClaw6 at 10:41 AM on October 31, 2013 [11 favorites]

If there's no medical reason, it's most likely for convenience, which is a terrible thing.

Anecdotally, I was induced at 42 weeks and 4 days. My son is 3 and awesome. Wait as long as you can. I still wish I had waited longer -- the induced labor was much stronger than natural labor would have been.
posted by woodvine at 10:45 AM on October 31, 2013 [6 favorites]

Best answer: Slate article from August: Your Doctor Offers to Induce Labor. Should You Say Yes? Has some links to research.
posted by Snerd at 10:45 AM on October 31, 2013 [2 favorites]

It would be for her convenience, not your health or the health of your child. Wait it out.
posted by checkitnice at 10:46 AM on October 31, 2013 [2 favorites]

Response by poster: Thanks, everyone. Your comments are generally in line with my thoughts so I appreciate the validation.
posted by emkelley at 10:55 AM on October 31, 2013

She might be just thinking out loud: "Everything's ready to go! Conditions are perfect! Let's do this!" She put it out there in case you wanted to take her up on it. You didn't, so that was that.
posted by ThatCanadianGirl at 11:03 AM on October 31, 2013 [6 favorites]

Because it was an offhand comment, I wonder if it has to do with this doctor's personal experience, preferences, prejudices... and dare I say, superstitions? Maybe she's on an anecdotal streak of better outcomes when she induces (which would be, um, unexpected, but...), or just attended an unusually difficult natural labour. Maybe she's delivered a lot of big babies lately. Maybe she has three other moms who are 41+5 right now, and it's stressing her out. It could just have been a thing a person said without really thinking about it... and that person happens to be your OB.

A good question to ask your doula would be whether she's worked with this doctor before? Maybe the doula will know something about the OB that can shed some light on this comment.

And, eep, on preview, the doula in me feels the need to speak up and say please don't spend a lot of time right now thinking about all of the bad things that could happen to you and your baby. Bad things can happen whether you induce or not, and thinking about them in advance won't help them not to happen. Relax, forget about the induction comment, and keep remembering the "EVERYTHING'S GOING SO WELL" take home message!
posted by snorkmaiden at 11:04 AM on October 31, 2013 [8 favorites]

Mod note: Folks, maybe be mindful of what's going on here and don't start replaying your best/worst scenarios here like you can't help it? Answer the OPs question, mind the drama and try to be helpful?
posted by jessamyn (staff) at 11:10 AM on October 31, 2013 [1 favorite]

Best answer: I am a labor and delivery nurse, but not your labor and delivery nurse. This is not medical advice, simply information to be considered.

There is some emerging information, gathered via retrospective reviews of birth outcomes, which suggests that there is a "sweet spot" of gestational age for delivery, at which time it's neither too early to risk preterm complications (respiratory problems, NICU admissions, etc.) nor too late for post-term complications (stillbirth, meconium aspiration, large baby). That "sweet spot" seems to be between 39-41 weeks.

That said, there is ZERO evidence to suggest that inducing labor during that time period prevents any complications. There has never been a study, and while reviewing retrospective data is interesting and could maybe prompt some well-designed studies, in and of itself it is not proof of anything at all.

There IS plenty of evidence to suggest that elective induction of labor presents its own risks, and most professional obstetric and midwifery organizations recommend against it.

My guess is that your OB found your cervix very favorable (which, hooray!) and thought, "Well, heck, why not try for that sweet spot?" And while I understand where that line of thinking comes from (facilitating the uncomplicated birth of a healthy baby to a healthy, happy mother really is the goal of the vast majority of OBs), there's just no formal evidence to back it up.

There is a lot we still don't know about pregnancy and birth, but the evidence suggests that in the absence of pregnancy complications, a spontaneous labor and vaginal birth is the best, safest option for mother and baby.
posted by jesourie at 11:16 AM on October 31, 2013 [24 favorites]

She might want you to deliver during her work hours not just for her convenience, but because she is fond of you, knows you, and would love to be there for the birth of your child. My OB was not on duty when my son was born; she stopped by to see us in the hospital but it would have been nice had she delivered him, given the many weeks we spent together at appointments!
posted by ThePinkSuperhero at 11:17 AM on October 31, 2013

Do you have any idea of the baby's size? I knew I was having a big baby, but still waited until 12 days post-due date to be induced. It would have been better to be induced because he was big(10+), and I had a c-section. Labor was not fast or terribly intense, likely because his big head had never engaged. It sounds like your baby is more typically-sized, and also sounds like things are progressing as they should, so trust yourself and do what you feel is right. I recommend sex, as progesterone may hasten labor, (may require every pillow in the house) and walking, as gravity may assist.

Wishing you & baby emkelley the very best!
posted by theora55 at 11:21 AM on October 31, 2013 [1 favorite]

Before you get all a "big baby aaah!" you should know that the later in pregnancy baby size is estimated, the less accurate it is. Lots of moms in my c-section recovery group were induced for "big" babies that turned out to be 7 or 8 pounds. And yes, induction does raise your c-section risk considerably. Rushing labor through medical means is a tool in the OB's tool box, and sometimes it's a great one, but it is not risk-free.

As with everything in pregnancy, nothing is risk-free. Inducing, waiting, whether or not you use epidurals, etc., all come with risks and/or benefits.

Your doctor is also, quite possibly, not fond of delivering on weekends, but that is absolutely her problem and not yours. No one made her become an OB who might have to work on weekends.

Speaking of which, ACOG themselves have come out against early induction for suspicion of large baby, absent other medical considerations. You might send your OB the link.
posted by emjaybee at 11:31 AM on October 31, 2013 [5 favorites]

Also, the older you are, the earlier they wish you would deliver. My friend just had a baby and her OB was thinking about induction at 39 weeks because of my friend's age -- all women's chances of adverse outcome start rising at some point, and I think that point comes quicker the older you are.
posted by feets at 11:37 AM on October 31, 2013

My wife was given the option of induced labor at her due date, or wait a week and if nothing happens, induce then. She opted to induce now, because she was ready to have the baby out (she's shorter, and our little guy was making her life rather uncomfortable).
posted by filthy light thief at 11:46 AM on October 31, 2013

She said it for no other reason than that is what she learned once upon a time should be done. It's absurd. If there were a medical reason for you to be induced, then absolutely you should be induced. But there isn't, so don't.
posted by zizzle at 1:32 PM on October 31 [5 favorites +] [!]

I vehemently refute this. My first child was borderline in terms of weight -- a big baby given my "medium" frame. Induction was contemplated, at length, at 38 weeks, by a board of obstetricians in order to avoid complications. It was rejected. Complications ensued and my baby was permanently injured.

After years, and surgeries, and much physical therapy, a lawsuit ruled in our favor, and the award exceeded our request.

She may be raising the issue because the birth weight projection is borderline, and she wants to deliver your baby intact.
posted by thinkpiece at 11:59 AM on October 31, 2013 [7 favorites]

I know you're curious, but we realllllllllllllyyyyyyyyyyyyyy do not know why she said that. There are so many possible reasons, and you have been given lots of them here. I'm in the camp of assuming the best of her since you have given us no reason to impute bad motives, but we're speculating here, full stop. Is this helping? If it were me, I'd call back and ask, because (although unlikely) there might be a valid medical reason for inducing you now. And you're curious.

Best of luck to you and baby emkelley! It sounds to me like you are in solid hands with your team.
posted by semacd at 12:06 PM on October 31, 2013 [2 favorites]

If there were actual medical reasons, any decent OB wouldn't have said "You should do this" and accepted your response without any further discussion. Given that she didn't, I urge you not to worry.
posted by Etrigan at 12:15 PM on October 31, 2013 [2 favorites]

I'm at 38 weeks, and just wanted to chime in about the interesting factors of human preferences, clinical philosophy and medical evidence that seem to be uniquely balanced in health professional I've worked without throughout this process. I've heard so much variation on ways to made decisions around every question from 'should I induce' to 'do I want my birth to be attended by medical resident or a midwife', to 'doula yes or no' to 'water birth or no', to 'epidural yes or no' or 'want to have skin to skin contact after delivery yes or no' or 'breastfeeding, yes or no', and on and on and on that really it is enough to make my head spin.

My sense now is it's not just that your OB GYN has preferences - personal, philosophical and evidenced based preferences that are probably just uniquely theirs. If the situation was reversed, they might be in your spot and ask for induction based on their combo of beliefs. Not just beliefs, but prioritization of those beliefs. So for them, a less painful birth with interventions seems more personally sensible than a possibly slightly larger baby without.

And since there is enough interesting evidence out there to support most perspectives, no matter what you believe (induction has potential consequences! Not inducing has potential consequences!), it's really hard to to know how heavily you - or any of us - should weight a particular study or statement like ' I wish you'd let me induce you now'. I mean, is she saying that based on her personal preferences she'd like to induce you now (who cares), vs her philosophical approach to care she'd like to induce you now (less relevant, but maybe her philosophy is babies should come out as soon as they seem viable, which isn't yours), or is there sufficient medical evidence to suggest that babies for women your age/demographic/who have had similar pregnancies to yours/who are having the number of babies you are with the potential health issues your baby do significantly better if they are induced at 39-40 weeks (okay, that's meaningful).

In this case, she didn't give you enough data to know - which sucks. But the fact that she backed off, suggests that it might be more personal and philosophical rather than medical evidence.

Good luck whatever you decide to do.
posted by anitanita at 1:09 PM on October 31, 2013 [6 favorites]

I think OBs go by worst-case scenario. So she'd rather induce you now and have a healthy baby and healthy mom, rather than waiting longer until the risk of stillbirth, etc, increase.
posted by yarly at 2:02 PM on October 31, 2013 [1 favorite]

Ouch, I can only imagine it's for your doctor's convenience. I always think inductions are the obstetric equivalent of choosing to replace a wall, instead of repainting (kind of, I know it's not a perfect comparison).

My third child (enormous) was induced, and it was really unpleasant so when I was preg with number four (not enormous) and she went over dates my ob was all keen to induce and I dug in my heels. We did a LOT of ante natal visits in the last couple of weeks and did an ultrasound to see how much amniotic fluid was still sloshing around to ensure the baby was still doing ok, and not over cooking. It's not like a huge secret mystery in there, "Oh noes, we must induced because anything could be happening and we can't tell!"
posted by Kaleidoscope at 3:59 PM on October 31, 2013

My time frame for induction was a projected 10 - 48 hours (10 the lowest estimate, 48 being when we'd c-section). It turned out to be 7 hours from gel to baby, and thus a 1am birth. Not exactly convenient for anyone - I was 37 weeks and induced for hypertension and dodgy bloods (glucose, liver function and so on). She was also quite big for gestational age, but still within bounds. I know my ob. was keen to induce in order to avoid the numerous complications that are more likely with the complications I had - I could have declined but it made sense to be under medical care for the entire labour rather than just the last bit.

That said, the process here in Oz starts with the cervical gel for at least 6 - 10 hours, with a second dose after that, and then pitocin (medical issues allowing). This adds an enormous level of variability to the timing of the birth and makes the 'easy to schedule' less about office hours, and more about days/weeks. Even with a pitocin induced birth I don't think it's nearly as neat as a lot of people like to assume or say.

In this case though? I vaguely recall that there have been some small studies that suggest 39/40 week inductions don't have as much of a negative effect as pre-term ones (before 38 weeks) and possibly even positive outcomes. But without an actual medical reason? I wouldn't, and I'd ask her what her reasoning is.
posted by geek anachronism at 5:00 PM on October 31, 2013 [1 favorite]

Best answer: Is it at all possible that she momentarily confused you for another patient? Perhaps there's another who looks or sounds like you whose circumstances are similar (but just different enough) and she had a slip of the tongue. Had you had any prior conversations at all about induction? If not, I think that would suggest she may have misspoken.
posted by Smells of Detroit at 5:49 PM on October 31, 2013 [1 favorite]

I am not saying this to scare you, but things sometimes (very rarely!) go horribly wrong at the tail end of a pregnancy that was fine up til that point. Like, healthy full term babies getting strangled by their cord and being stillborn, which happened to a friend of mine. I think you should ask your OB what she meant by the remark, and I bet she'll say that all things being equal, if a baby is ready, some tiny but terrible risk to the baby is averted if you just go in and get it while things are known to be going well.
posted by fingersandtoes at 8:02 PM on October 31, 2013 [1 favorite]

IANYD, but there are a few reasons: are you diabetic? Was your early glucose screen elevated? Is there a chance that your dating is off (did you find out about your pregnancy in the second trimester, or get pregnant with irregular periods?) Does she think your baby is very big? And why were you getting a BPP? These factors can all lead to indications for induction.

My question is: are you having contractions? By the sound of your cervical exam, your body is alrewdy into early labor. To me, in the absence of other risk factors, that means there is no indication for induction, but some docs have a more pro-active approach.
posted by stillmoving at 8:27 AM on November 1, 2013 [1 favorite]

I'll add one more data point. Things can and do go wrong at the very last minute with no warning whatsoever. My wife had a picture-perfect, textbook-example pregnancy. Everything looked exactly within expectations and fantastic at every appointment. Like you, we wanted as natural a labor/delivery as possible and had no reason to think that would not happen. In the early morning on our exact due date, light contractions started and progressed exactly as expected throughout the morning. About mid-day her water broke... and broke and broke and broke! Way more fluid came out than we were expecting, and it kept coming, and then it turned to red fluid, and then it turned to blood in the car while we rushed to the hospital, freaking out the entire way of course. It turned out my wife had a placental abruption (placenta separated from the wall of the uterus) sometime during early labor. She had an emergency c-section within 1 hour of arriving at the hospital.

I imagine it only takes one of those kinds of scenarios to convince a doctor that the minor risks of inducement are totally worth taking in exchange for the benefit of having the whole event happen in a predictable, scheduled, controlled environment with all the tools of modern medicine available in mere seconds.

By the way, everyone in my story turned out just fine (modern medicine rocks!) and we now joke that our son was so eager to enter the world that he tripped on the cord and ripped out his life support system when he was rushing for the exit door :) .
posted by stoffer at 10:08 AM on November 1, 2013 [3 favorites]

Response by poster: Update: no baby yet.

At my next visit, it became clear that the OB thought I was due the day after the visit that inspired this question, rather than a week later (today). So the whole situation makes a little more sense to me.
posted by emkelley at 2:12 PM on November 8, 2013 [4 favorites]

Response by poster: Update #2: baby emkelley was born on Friday night, and he *is* big: 9 lbs 2 oz. I ended up with an emergency c-section due to placental abruption, but both of us are healthy and happy now! Luckily we were already at the hospital for testing when the bad stuff started happening.
posted by emkelley at 1:11 PM on November 17, 2013 [5 favorites]

Congratulations! I've been checking back in hopes of baby news, so thanks for the update. So glad to hear that you and baby emkelley are safe and happy! :)
posted by snorkmaiden at 11:57 AM on November 18, 2013

Yay! Congratulations!
posted by ThatCanadianGirl at 3:07 PM on November 19, 2013

Response by poster: Baby emkelley!
posted by emkelley at 7:54 AM on February 17, 2014 [3 favorites]