When you daydream about how your labor will begin, chances are you imagine nudging your slumbering mate to announce, "It's time!" According to the National Center for Health Statistics (NCHS), though, it may well be your doctor who utters these long-awaited words. The latest NCHS report found that the percentage of women whose labors were induced (some for medical reasons, some not) increased from 18 percent in 1997 to 22 percent in 2006.
Why is nature so apt to get a nudge nowadays? "One reason is that doctors have become much more aggressive about inducing labor in pregnancies that go beyond 42 weeks," says Charles Lockwood, M.D., chair of obstetrics, gynecology and reproductive sciences at Yale University School of Medicine. Prior to the 1990's, physicians generally let pregnancies linger unless there was a clear problem. "Secondly, because (labor-inducing) agents are more accessible than they were years ago, obstetricians are more inclined to induce in borderline cases, which may not be necessary. And finally, an increasing number of inductions are done simply for a physician's or a patient's convenience."
Concerned about the soaring induction rate, the American College of Obstetricians and Gynecologists (ACOG) has issued guidelines on the practice: It now recommends that practitioners wait until at least 39 weeks whenever possible and do the procedure only when the benefits of delivery outweigh the risks.
Of course, a tired, cumbersome, and impatient expectant mother may welcome anything that hastens delivery day. But kick-starting labor has a number of drawbacks: The most common labor-inducer, intravenous Pitocin (a synthetic form of the contraction-triggering hormone oxytocin) requires a woman to be in the hospital for her entire labor, boosting the odds of other medical interventions. The drug also brings on sudden, intense contractions, so pain medication is a must for many women. And since these powerful contractions can cause fetal distress or even uterine rupture, constant electronic fetal monitoring (EFM) is needed. The false alarms that are typical with EFM can, in turn, lead to unnecessary c-sections. Plus, "there's a chance the induction won't work," says Dr. Lockwood. "In that case, there's a lot of pressure to deliver surgically."
To avoid the pitfalls of Pitocin, find out well ahead of time how often and under what circumstances your doctor induces. If induction is inevitable, consider talking to your health care provider about trying one of these alternatives first:
MEMBRANE STRIPPING Breaking the delicate membranes that bind the amniotic sac to the uterine wall causes the release of natural prostaglandins that will soften the cervix and may trigger contractions.
SYNTHETIC PROSTAGLANDIN GELS Ripening the cervix may bring on labor without the use of additional medications.
BREAKING YOUR WATER Treatment triggers the release of the contraction-stimulating hormone oxytocin.
If there isn't a clear health reason to hurry Mother Nature along, however, don't be shy about asking to wait, advises Dr. Lockwood.