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Glenn D. Braunstein, M.D. Headshot

Electively Induced Labor: Remember, For Babies' Sake, Every Week Counts

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No anticipation exceeds the excited wait for a baby to be born. There are weeks of squinting at ultrasounds to see the little person who will change everything, countless hours wondering about the sex of the baby and months of feeling for that first tiny kick. The expectant family fusses endlessly over just the right name, right crib and paint color for the nursery walls.

While all that parental hoping and yearning goes on, prospective moms, in particular, take on pragmatic, logistical concerns: will the obstetrician be available when it's time to deliver? Can we get to the hospital fast enough? Will my spouse be in town or off on a business trip?

With the breakneck pace so many people live these days, surrounded by dozens of chirping devices to keep them on their drum-tight schedules, there's a temptation to meddle in Mother Nature's plans to press for more certainty about exactly when baby arrives.

But when it comes to giving birth, it's best in the vast majority of cases to follow a natural course. Indeed, medical experts have pushed hard to encourage women in California, and across the nation, to follow the reasoned and evidence-based guideline laid down by the American College of Obstetrics and Gynecology in the 1970s.

Unfortunately, in recent years, fewer patients and doctors have heeded that sage counsel, and the number of elective inductions -- births induced or brought on with medical interventions without a specific medical reason -- has skyrocketed.

The rates for medically induced labor more than doubled between 1990 and 2006, to 22.5 percent from 9.5 percent. Linked to this trend is an increase in the number of cesarean sections: nearly one in three births occurs now with this procedure, elective or otherwise.

Leave it to Mother Nature

Babies, alas, cannot be hurried through their development. Through the late weeks of gestation, their brains, lungs and livers keep growing and developing to ready them for the world. At 35 weeks, their brains are only two-thirds the size they will be at 39 to 40 weeks.

And as difficult as the last few weeks of pregnancy can be on mothers, they are vital to ensuring healthy starts for babies. A recent study by the March of Dimes, National Institutes of Health and the Food and Drug Administration found the risk of death -- however small -- more than doubles for infants born at 37 weeks compared to those carried to a full 40-week term.

This research underscores why it is crucial for mothers to carry their babies to at least 39 weeks, rather than opting to induce delivery -- unless it's medically necessary.

While babies born at 37 and 38 weeks technically are not considered premature, they are at higher risk for a stay in neonatal intensive care. Babies delivered early also face increased respiratory problems and the need for increased ventilator support, as well as increased incidence of bloodstream infections. They have a higher risk of vision and hearing problems. They have difficulty keeping warm enough and often require time in an incubator. Babies born after 39 weeks can better suck, swallow and stay awake long enough to eat.

Induced labor also is linked to: a higher incidence of vacuum or forceps-assisted vaginal delivery; problems in labor, including fever and shoulder dystocia (when the baby's shoulder gets "stuck" in the birth canal); fluctuations in fetal heart rate; jaundice; and longer hospital stays.

Is There An Exception?

In some cases, it may be medically necessary to induce labor. Some reasons to undertake such procedures, as suggested by the American College of Obstetrics and Gynecology, include: pregnancy-related high blood pressure; infection in the uterus; and leaking amniotic fluid without labor starting or a placental abruption -- that is, the placenta, which nourishes the baby, peels away from the uterus, a very rare complication requiring immediate attention. A physician may induce labor if a child is way over his or her due date, as after 42 weeks, when the placenta may not function as well as it did before.

Why do so many women induce labor? It appears many are unaware of potential dangers and complications. A 2009 survey of insured women who had recently given birth found that only a little more than a quarter of those asked chose to define a full-term pregnancy as 39 to 40 weeks; more than 92 percent asserted that giving birth before 39 weeks was safe. A campaign developed by the March of Dimes, California Maternal Quality Care Collaborative and the California Department of Public Health aims to educate patients, physicians and all health care workers on how key it is to wait at least 39 weeks before inducing labor.

The campaign offers excellent advice to patients, including speaking up if their doctor or nurse midwife suggests a delivery before 39 weeks. Be sure you understand the problem or complication that requires this step. If there isn't one, ask to wait until 39 weeks unless there is a sound medical reason. Likewise, be sure you understand why your caregiver plans to induce labor, how this will done and what risks this entails -- including whether there will be heightened chances you will need a cesarean section.

Due Date Details

Women, of course, should understand, fundamentally, that their due date can be inexact. It generally is based on information about their last period, results of lab tests and ultrasound measurements taken of the baby. Even with that data, the due date still is just an estimate; it could be off by two weeks or so. While a woman might contemplate inducing delivery at 38 weeks, she might be only 36 weeks along -- and her baby would be premature. Likewise, don't fret if labor starts naturally -- or spontaneously -- after 37 weeks. Due dates are an estimate, and a mother might be further along than believed.

While scheduling a birth might seem convenient, the reality is different. Labor should be induced only when demanded to protect the health of a mother or her baby. It is inconvenient -- to say the least -- when the processes don't work and the mother is sent home to try another day. It is more than inconvenient when it leads to cesarean surgery -- a major abdominal procedure for women, with all the risks, complications and long recovery time that accompanies such surgery. Also, once a woman has a cesarean section for one pregnancy, she is much more likely to have C-sections for subsequent babies.

Labor begins when the baby, placenta, uterus and hormones are in sync and ready. Babies should be allowed their vital last stages of development. Those are not to be sacrificed for convenience. That is a reality that not only expectant mothers and fathers should keep in mind -- physicians should take heed, too.