Labor Induction: Reasons, Methods & Risks

Women are opting for induction of labor more than ever. ACOG (The American College of Obstetricians and Gynecologists) says that over 20% of pregnant women are being induced prior to natural labor. While there are some medically prudent reasons to induce labor, up to half of labor inductions are elective - due either to doctor or mother convenience, impatience at the end of pregnancy, and care provider fear of litigation.

What Is Labor Induction?

Induction of labor is any action taken to artificially force labor to start. This includes stripping or "sweeping" of membranes (care provider manually separates the amniotic sac from the cervix), applying prostaglandins to the cervix in an attempt to stimulate uterine contractions, and/or the administration of pitocin - an artificial labor hormone designed to mimic oxytocin, which is the body's natural source of labor hormone.

Reasons for Labor Induction

Induction of labor is used for a variety of reasons: while the exact percentage of elective inductions (medically unnecessary) is not known, according to the Agency for Healthcare Research and Quality - a division of the U.S. Department of Health and Human Services - the rate of induction outstrips the rate of medical reasons to do so. This shouldn't be surprising, as the rate of labor induction has more than doubled since 1990 - an alarming statistic which is in no way justifiable.

Medical reasons for labor induction can include: high blood pressure, uterine infection, or medical conditions which threaten the health of the mother or baby. However, these are fairly rare and special care should be taken to weigh the risks - if at all possible, the healthiest thing for the baby is to gestate until he is truly ready to be born.

What Are the Risks of Labor Induction?

Artificially inducing labor may cause longer, more painful labor, fetal distress, and unnecessary cesarean section. This is due to several factors: chemically induced labor is harder on the uterus, producing more painful contractions than those created by natural labor. Contractions resulting from labor induction tend to be longer and stronger, robbing the uterus - and in turn the baby - of precious oxygen. In addition, because women undergoing labor induction are typically put on continuous fetal monitoring, their mobility is restricted, making the pain more difficult to deal with. This results in higher rates of pain medication usage, which can also negatively affect mom and baby.

One of the most serious risks of labor induction is the increased rate of cesarean section. A study at the Northwestern University Medical School in Chicago revealed that first-time moms who are induced end up with cesarean sections at a rate of 2.5 times that of moms whose labors are spontaneous. Why should you care about the increased cesarean section rate following labor induction? Because cesarean increases the risks of all future pregnancies. Cesarean confers higher risks of abnormal placental implantation, miscarriage, and uterine rupture.

Ultimately if there is no immediate risk to mom or baby in continuing the pregnancy, the risks of induction outweigh the benefits. Birth happens more easily and safely when the baby is permitted to come on his or her own timetable.

References:

http://www.acog.org/publications/patient_education/bp154.cfm

http://www.ncbi.nlm.nih.gov/pubmed/10511367:
Seyb ST, Berka RJ, Socol ML, Dooley SL. Risk of cesarean delivery with elective induction of labor at term in nulliparous women. Obstet Gynecol. 1999 Oct;94(4):600-7.

http://www.ahrq.gov/clinic/tp/eiltp.htm