Why does everyone get induced? What’s going on here?

Opinion piece here…As I’ve been on this journey of birth for a few years now, with my first son (born by cesarean in a hospital) and now awaiting the birth of my second son (planning to birth at home with a licensed midwife), I have been reading a lot and keeping my ears open to others’ experiences. I am not a “everyone should do home birth” kind of a person, I don’t know anyone who is. Nor am I judging women who choose elective induction. If that is something someone really wants, that is cool, I am pro the woman’s choice. BUT, I don’t think that women are actually given the full spectrum of information about elective induction which is the main problem AND it is being suggested by far too many medical professionals (mostly OB’s in hospitals) when, many times, it isn’t actually in the best interest of mother and baby. I think a lot less women would be saying “yes” to suggested inductions if they were given the whole picture. For example, a mother’s mental well being post baby is actually extremely important for one: the woman and two: the health of the baby. The whole “as long as you have a healthy baby, healthy mom” comment, is hardly ever referring to a woman’s postpartum health or just her mental/physical/spiritual health in general, or the baby’s. Studies show that emergency cesareans (which can rise from elective inductions) give a 15% higher chance for a woman to develop postpartum disorder. There is also the issue of clarifying when inductions are medically necessary versus elective. For example, the fear tactic of “your baby is big and you’re close to your due date so let’s induce” is NOT medically supported. (The ACOG finally just came out and admitted that ultrasounds can’t accurately predict a baby’s weight for example.)

I am just thinking of this today as literally within the past two days I’ve heard of two women I know being induced. One of which is getting induced the day after “40 weeks.” Now, to me… due dates are a joke. They aren’t accurate. A woman isn’t even considered “post term” until after 42 weeks and that is just a guideline of the ACOG. In some countries, it’s later. Unless there is a major medical reason to induce, it seems more logical to just let the body and baby go into labor when ready, so labor isn’t horrible for the mother. Induced labors in general are actually harder than spontaneous labors because the body is being forced into it. I have friends who shared with me how their kids went into distress once given pitocin. It was clear that the baby didn’t like the “force me out” method. My mom said once she was given the epidural that her labor stalled.

If someone doesn’t want a major abdominal surgery with all that comes with it (possibly not having skin to skin right away, possible problems nursing, possible problems with breathing for baby, a much higher likelihood of postpartum depression, etc.), one should really consider saying yes to any kind of induction method because of what’s called the “cascade of interventions.” Once this process is kickstarted, let’s say with being given some pitocin when the body has shown no signs or minimal signs of readiness, the woman is then typically put on a clock at that hospital for things to happen in a certain amount of time. She is also catapulted into a lot of pain (not the natural way of the body and brain chemistry working together) which leads to a need for an epidural, which can totally halt the progress of labor because a woman can not feel what is happening to intuitively breathe or push the baby down. NOT to mention, once given synthetic drugs to induce a woman is put on continuous fetal monitoring devices which also unnecessarily lead to more interventions and she is most likely stuck on her back in a bed which makes labor much harder and less efficient. (Please look at my resources page and this quick article with a caption below).

“The Listening to Mothers survey reported that almost 50% of the women surveyed had their labors induced (Declercq, Sakala, Corry, Applebaum, & Risher, 2002). Physicians are astonishingly up-front in discussing how much more efficient scheduled inductions (and scheduled cesareans) are. They claim that women will not have to worry about middle-of-the-night births and that hospital staffing and bed turnover can be better managed. Both physicians and women seem to be comfortable with “intervention-intensive” labor and birth.

Women are between a rock and a hard place. It is so easy to be seduced into believing that the baby is ready for birth. It is also frightening to hear the physician talk about a too-large baby or a possible medical problem. In the first instance, potential problems are brushed aside; in the second instance, problems are suggested where none are likely to exist. In both cases, pregnant women do not have the full information required for making a truly informed decision.

To make an informed decision—either informed consent or informed refusal—women need to know the value of waiting for labor to start on its own. The last days and weeks of pregnancy are vitally important for both the mother and her baby. The end of pregnancy is as miraculous as its beginning. It’s a lot easier to say “no” to induction if the mother knows the essential and amazing things that are happening to prepare her body and her baby for birth.” (“Saying No to Induction” The Journal of Perinatal Education by Judith A. Lothian, PhD, RN, LCCE, FACCE)

I remember with my first birth, the CNM saying, “Don’t worry, having the section at 39 weeks is perfectly fine. The baby is done developing.” In my gut, I had a problem with this. Although I accepted that most likely he wouldn’t turn at that point (he was frank breech), I felt it was not right to not let my body at least go into labor on it’s own and then go in for the cesarean, but I succumbed to the fear tactic and went with what they said “I had to do.” If you access the risks with either choice (c section scheduled without any indication of labor at 39 weeks vs let labor start then have the c section), I think it’s less risky go with the later and gives many benefits for baby and mother to allow body to at least start the process.

Now, that all said, with the info I have now I would’ve sought out an OB who delivered breech babies but I have also thought about how going into labor is usually better for the mom and baby. It’s not convenient for doctors or hospitals though.

If anyone out there is pregnant and hoping for a spontaneous labor with little to no interventions, I would highly suggest you ask your provider lots of questions very early and do your homework on the provider/institution in which you are planning to deliver as per their rates and policies (with a 50% induction rate going on and a 31% cesarean rate going on in the US… it is very clear that it’s actually harder for a woman to birth without interventions in hospitals than it is to have them.) Also, switch providers as many times as needed to find one that lines up with your beliefs and “gut.”

Co-Care: What a concept!

Oct 23, 2019: 16 week appt with OB

I saw my OB today (one of three main male doctors recommended for vbacs in the area) for the 3rd time (8, 12, 16 weeks) and discussed my plans for transferring to a midwife for the rest of my care for planning a home birth. I was very happy with the experience and his willingness to meet me where I am at, be honest that I have a very “uneventful” pregnancy going on (a good thing), and he said I can come back and see him towards the end, before labor, perhaps at 35 weeks if I wanted. ( I had asked him if he’d be open to that should I want to.) I was super happy with this “co-care” methodology and I believe it’s how all maternity care should be which is: flexible and going with the needs and desires of the mother as well as treating the pregnancy as it is, a low risk, normal pregnancy (regardless of one prior c section due to breech). He gave high remarks about the two midwife groups I told him I was considering and spoke highly of his hospital which is five minutes from my house should I have to transfer there during birth. He said it was the best hospital around for taking homebirth transfers. He shared how some other “good” hospitals around would not be so open and ok with it. You would be met with a tone of “oh another one of those homebirthers are here” kinda a reaction at many hospitals which is obviously not cool. I wouldn’t be able to cal him in labor, but if later in the pregnancy things change and I am high risk, then I’d switch back to seeing him or see both him and the midwife. He normalized the whole thing for me which in my head I can sometimes think, “I’m the first to be doing this.” Absolutely not. I am a normal, pregnant woman, with nothing showing up of concern. It is natural for me to not need medical interventions. It’s just against our cultural norms now of everyone going to an OB and all births “needing” hospitals.

Prior to my experiences in the last four months, I never even realized I could have co-care, which essentially means I can see who I need to see without an “allegiance” to one provider. Call me crazy…but that sounds like how it should be. I’m hoping we can see a shift to more of this in our country to lessen the amount of unnecessary interventions, which lead to c sections, and trauma many women experience with birth… midwifery care for most pregnancies unless/until the pregnancy necessitates medical interventions, and therefore an OB. Medical interventions and good OB’s are gifts to this world for the moments that are actually necessary.

I’ll see where I’m at by the end of this pregnancy. Perhaps I’ll actually need an OB or a hospital, and I will then seek it out. But for now, it appears that all is well with my pregnancy, and I believe in normal, healthy physiologic childbirth.

Have anyone else had a positive experience with establishing co-care with a midwife and an OB?

Quick reference: The following is an excerpt from the Journal of Perinatal Education.

A normal physiologic labor and birth is one that is powered by the innate human capacity of the woman and fetus. This birth is more likely to be safe and healthy because there is no unnecessary intervention that disrupts normal physiologic processes.17 Some women and/or fetuses will develop complications that warrant medical attention to assure safe and healthy outcomes. However, supporting the normal physiologic processes of labor and birth, even in the presence of such complications, has the potential to enhance best outcomes for the mother and infant.18–,21

Normal physiologic childbirth

  • • is characterized by spontaneous onset and progression of labor;
  • • includes biological and psychological conditions that promote effective labor;
  • • results in the vaginal birth of the infant and placenta;
  • • results in physiological blood loss;22
  • • facilitates optimal newborn transition through skin-to-skin contact and keeping the mother and infant together during the postpartum period; and
  • • supports early initiation of breastfeeding.1

The following factors disrupt normal physiologic childbirth:

  • • induction or augmentation of labor;23–,25
  • • an unsupportive environment, i.e., bright lights, cold room, lack of privacy, multiple providers, lack of supportive companions, etc.;26,27
  • • time constraints, including those driven by institutional policy and/or staffing;28
  • • nutritional deprivation, e.g., food and drink;29
  • • opiates, regional analgesia, or general anesthesia;30,31
  • • episiotomy;32,33
  • • operative vaginal (vacuum, forceps) or abdominal (cesarean) birth;6,34
  • • immediate cord clamping;35–,37
  • • separation of mother and infant;38 and/or
  • • any situation in which the mother feels threatened or unsupported.39