OB/GYN Explains Induction of Labor: Pros, Cons, and What You Need to Know
hi it is so great to see you again today we are
going to talk all about inductions of labor why you might need one how they happen and kind of
what to expect yeah and over the course of this episode we're going to be answering questions that
you've asked us directly as well absolutely so if this is your first time meeting us i'm sarah
i am a board-certified ob gyn and a new mom i'm kurt i'm a board-certified pediatrician
and a new dad and we are the doctors bjorkman welcome back we are the doctors
bjorkman as we mentioned and we have detailed our own recent pregnancy
and experience as new parents trying to cover everything from trying to conceive through
pregnancy and now parenthood bringing our medical expertise and now new real life experience to you
guys every week yes so if you're not subscribed to our channel please do so you can keep up
with the great content we have coming for you this week we are talking all about inductions
of labor um it's an episode we have gotten tons of requests for so we're really excited to dive
into that you know there just seems to be a lot of you know buzz about inductions on social media
a lot of our friends and family have been induced and so it seemed like the perfect time to go
into it um just because there can be a lot of angst and drama surrounding inductions of labor
so we want you to have the facts and the evidence so maybe we could start by having you say what
is an induction anyway sure so an induction or an induction of labor or an iol we sometimes
call it is our goal is to induce labor meaning to start labor and so if you remember from our am
i in labor video labor is when you start having regular strong uterine contractions that cause
that cervix to change and dilate and often that happens spontaneously um but up to 20 more than
22 percent of pregnant women will undergo an induction of labor here in the united states
and that's more than doubled since the 1990s so the goal of an induction of labor is to kick
you into labor to achieve a vaginal delivery so an induction of labor is using medications to mimic
the body's hormone to get the process of labor and childbirth started yes okay but why doesn't
everyone just do that naturally that's a great question and it's honestly something we don't
have an answer to why do some women go into labor really really early we have a whole episode about
you know what happens if my baby's born early we don't understand why some women don't really kick
into labor at all they're we know there are a lot of things going on behind the scenes with your
cervix and remodeling and changes in hormones but we don't all exactly understand the timing and
signal changes that are happening you know some women take a long time to kick into labor some
women have super fast labors we don't understand exactly why that happens but it is a topic
that is constantly being researched in ob gyn so why would someone have an induction then
well there are really two big categories for why people get induced and the first category
is inductions that are medically necessary pregnancy generally is a state of wellness however
some people have medic complex medical conditions or other things that make pregnancy
a very high risk time for them and pregnancy can complicate these medical
conditions that people have at baseline other things that happen in terms of mom's health
that we think about inductions for are things like preeclampsia hypertensive disorders of pregnancy
uncontrolled gestational diabetes or cholestasis sometimes it's also medically necessary for the
baby's health to be born and have that labor induced this could be either the baby is showing
signs that it is not doing well this could be poor growth or that there's low fluid levels in the
uterus also going post dates can be dangerous for that baby inside mom too we know that the
risk of death in infants is twice that if they get to 42 weeks gestation as compared to babies
born at 40 weeks there's risk for infection in the uterus there is risk for cord compression and
other things as that placenta is really kind of aging and meeting the end of its efficiency and
supplying nutrients that baby needs the other big category we have medically necessary
inductions of labor and then we have what we call elective inductions of labor and so that means
there is not a medical reason kind of pushing us to induce labor but anyone after 39 weeks can
choose to be induced and so what is it about that 39 week mark we might ask the pediatrician
yeah so full term in terms of full development of a developing baby is considered any time
after 37 weeks gestation we know however the babies born at the 37 38 week mark have a
slightly increased risk of some minor breathing issues and then balancing that against the risks
of going too long and so week 39 seems to be this relatively sweet spot for babies development while
avoiding some of the risks of going too long right so let's talk about how an induction works so as
we mentioned we're using medications to mimic the body's natural process of getting that cervix
to dilate and soften um and then getting those contractions started to push that baby out exactly
so let's talk about the cervix for a second it is really an amazing organ um it goes from being
closed and firm to keeping that baby in through out your pregnancy to being soft and dilated to
10 centimeters to being able to let that baby exit the uterus sometimes the cervix is starting
to soften as you get towards the end of pregnancy but sometimes that cervix is still very firm and
very close when you reach the end of pregnancy um and so there are things that your ob can do to
help soften that cervix or ripen the cervix to get it ready for labor and some of the things we
can do are medications that you can either take orally or vaginally they're called prostaglandins
and those help to soften the cervix sometimes they can cause contractions sometimes they do not and
depending on the type of prostaglandin use they can be given to you every four hours or every 12
again to help get that cervix soft and ready to go awesome and then obvious often use things like
foley balloons too right can you explain that yes so a foley balloon is just like it sounds they are
also used in the bladder to drain the bladder but with a foley balloon for inducing labor it is a
form of mechanical dilation so what that means is your cervix is usually about one centimeter
dilated and you take a foley balloon it's kind of like a soft rubber straw that you pass through
the cervix and then you inflate that foley balloon once it's up through your cervix in the uterus and
so you fill that foley balloon with normal saline and just by that foley balloon being there in your
uterus it is causing the release of hormones and prostaglandins so it's helping in that respect but
it's also kind of mechanically dilating often um there is some traction on that um tail
of the foley balloon and so it's also one that foley balloon kind of works its way out
of your cervix you're three or four centimeters dilated so often you may have to be a little bit
dilated to get a fully placed so you may start out with some of those other medications
you may be able to do a fully with those medications you may start with a foley it depends
on hospital policies and what your ob gyn prefers sometimes a foley can be placed in the office
and then you go home sometimes you do it as an inpatient in the hospital again it just depends on
your practices and hospitals policies and way they do inductions so with all these different options
about inducing labor how do they choose what to do honestly it depends on how your cervix feels
and how dilated you are so you will have a vaginal exam and then your ob will kind of make
that choice it's also very um regional in how inductions happen and how your hospital does
it also keep in mind that getting your cervix ready to go can take a long time so hang
in there it can take more than 24 hours to get a cervix ripe or ready to go in someone
who started out with a really unfavorable cervix that was very closed very firm very posterior okay
so then once the cervix is ripe so it softened a little bit it started to dilate what happens next
so you may be someone who comes in at two to three centimeters um and is ready to go or maybe you had
to do some prostaglandins and a foley to get your cervix um right but once you get to that point now
it is time to give you pitocin to give you those strong uterine contractions to push that baby
out so pitocin is synthetic oxytocin and oxytocin is the hormone that your brain makes to cause
strong uterine contractions and so now we need those strong uterine contractions so baby's head
is pushing down on that cervix to dilate it all the way to 10 centimeters and then it's delivery
time of course if you are having an induction for a medical reason it is important that you do
that for your health or for babies health or both for whatever reason that is your medical team has
decided that is safer for you or baby or both of you for that baby to be on the outside and that
decision and recommendation is not made lightly by your team but now let's talk about elective
inductions or choosing to be induced at 39 weeks or beyond yeah and so there's some historical
older studies that compared women who came in in spontaneous labor already compared to women who
came in and then had these elective inductions and some of those older studies showed that women
who had elective inductions had longer labor times and possibly a higher rate of c-sections
but when you think about these two groups that were in some of these older studies they
weren't really comparing apples to apples and it's not surprising that someone who comes in in
labor already is going to have a shorter labor because they don't need the process of the extra
medications and folia bulbs to get things going right that makes more sense that when you're
coaxing labor to happen it's going to take longer so the big question though that wasn't
addressed by these historical studies is what happens to women who have not gone into
labor on their own by 39 weeks of course it is great to go in a spontaneous labor but if you've
made it this far in pregnancy is it better to be electively induced or is it better to just
watch and wait and see what your body does so this brings us to our discussion
of the ARRIVE trial this was a very well done randomized control trial that was
completed in 2018 to look specifically at the question of how outcomes vary between women
who undergo elective induction at 39 weeks versus those who continue that wait and see
what happens approach so before i go any further a couple very important things to mention
about this study number one this study was looking at first-time moms who were healthy and
otherwise low risk and whose babies were head down number two there is a lot of nuanced discussion
about the topic of elective induction so please be sure to talk to your ob provider about this
if it's something you're interested in because hopefully they know you your medical history
and your goals for birth better than anyone so as i mentioned this arrived study was really
a good study um it was completed at 41 different centers in the united states and it has really
helped to change the collective thought in the ob gyn community about kind of how we view inductions
so in this study they recruited over 6 000 healthy first-time moms and half underwent induction at 39
weeks and the other half were in that weight and c group and so they were allowed to go into labor
naturally or ended up being induced for medical reasons which also included making it to 40 and 5
at which time all the remaining women were induced so what did they find so they found that induction
did not have a significant effect on death or serious complication in babies either way for
the moms who were electively induced this was linked to lower c-section rates so 18.6 um in
the elective induction group versus 22.2 percent um in that and see group for babies um the
outcomes between the two groups were very similar um but those babies in the elective induction at
39 weeks group they had a slightly lower rate of needing breathing help after birth overall moms
who were induced ended up spending more time in the hospital as you would expect again if we're
trying to coax you into labor you might end up spending more time there but they did spend less
time kind of postpartum in the hospital so the question should everyone be induced at 39 weeks to
lower the rate of c-sections although this study may be helpful with making informed decisions
it doesn't mean everyone should be induced also it doesn't mean that elective induction at
39 weeks lowers the risk of c-section for every individual there were more than 22 000 women
who were eligible to be in this study and only 6 000 women volunteered to participate which
i think just goes to show that not every woman wants to have an elective induction and medical
intervention in their pregnancy and that's okay so the american college of obstetricians and
gynecologists did however release new practice guidelines that address the arrived trial
findings they concluded that it's reasonable to offer elective inductions to low-risk
first-time moms at 39 weeks of pregnancy however they urge care providers to first consider three
important factors so number one and most important the values and preferences of the pregnant woman
number two is the staffing and facility resources that are available again to assist with
those possibly longer labors with an elective induction and the number three which
is also really important is they encouraged these providers to make sure they are reevaluating
and assessing their protocol for when they decide to call a failed induction again not wanting
to call an induction failed too early and there are certain criteria that acog recommends ob
gyns use before making the decision to say hey this induction didn't work we need to consider a
c-section because we want to give moms a really good chance to have a safe vaginal delivery now of
course some women want to have that experience of natural labor that is totally understandable
whether it's having a non-medicated labor or you know definitely some people feel like
they don't want to force their body maybe to do something that's not ready i think it's
interesting that the arrived trial shows that you know sometimes it's actually better to help
the body do the things it's naturally equipped to but just doing it on a timeline that maybe is
safer for mom and baby yeah so whatever you decide whether you want to be electively induced at 39
weeks or you want to wait and see what happens it's just important to know that induction of
labor at 39 weeks doesn't increase your risk of getting a c-section it decreases your risk of
some of the hypertensive disorders of pregnancy and may decrease your risk of your little one
needing respiratory support so very safe for mom very safe for baby of course you have to decide what is best for you and what feels important for
you in terms of what you want for your experience if you find yourself needing an induction it
means that you fall into one of two categories one you are in that medically necessary group
meaning that something is going on either with your health or with babies that means you
need your team things you should be delivered now and that may be something that you
knew was coming or it may be unexpected and that can make that can be kind of scary and
make you very nervous and there's a lot of emotion surrounding that so again want to make sure you're
communicating with your ob team and your partner and your family and all of those things so you
feel as supported as you can during that time on the other side of it there is the group of
people who is considering elective induction um it means you you're 39 or 40 weeks pregnant
and you haven't gone into labor spontaneously um and that can you know that isn't also exactly
what you imagined and so that again can be a little bit scary and trying to decide what to do
so again i when you are being induced it may not be that ideal situation that you had planned for
and so communication with your ob team is really important so that you feel like you understand
what's going on with your care what the plan is and feel as empowered as possible for your
birth even if it isn't exactly what you expected so to wrap this up let's kind
of talk about the pros and cons of an elective induction of labor and the first
thing i kind of put in the con category is that um generally speaking inductions take more time
we are trying to coax your body to do something we have to get your cervix ready we're giving you
contractions so your induction may be longer than spontaneous labor you may spend more time in the
hospital another potential con of an induction is that once you start a medication
called pitocin which is given to help augment those contractions your ob gyn is going to
want you on continuous monitoring to see how well the baby's tolerating those contractions
that they're getting your uterus to do and so if you're hoping to have intermittent
monitoring throughout your labor process maybe an elective induction isn't the best for you another
con um is that there is this idea that inductions are more painful um and there isn't great data on
this either way however it makes sense that maybe um induced contractions are different than
spontaneous ones yeah and as we already mentioned it's kind of interesting in the arrived
trial that those women who underwent elective inductions actually reported lower levels of pain
than those women who had spontaneous labor that's very true and i would guess maybe that is because
the women who were being electively induced were in a hospital setting and so when they realized
they were at that point at the threshold where they wanted pain medication or an epidural it was
immediately available to them and they had control over that as opposed to maybe women in spontaneous
labor who are laboring at home you know their pain kind of starts to escalate as they're on their way
to the hospital kind of white knuckle um trying to get there dying for that epidural um so maybe
that is part of that difference one other thing to keep in mind is that because elective inductions
can sometimes take longer than spontaneous labor hospitals aren't always able to accommodate every
elective induction of labor and so it's important to talk to your ob gyn sooner rather than later
as your hospital may be booking these out weeks to months in advance so with all of that what
were the pros of induction so as we discussed with the arrive trial your risk of c-section
was lower the risk of hypertensive disorders of pregnancy is lower and then that risk of baby
needing respiratory support was also decreased so definitely things for the pro column yeah
there's also the potential to have a little bit more control over when baby comes with the ability
to schedule your induction yeah absolutely that is awesome it is so empowering for many women to
feel like they have a little bit of control over a very um uncontrolled process it seems and so
knowing just knowing that hey if i get to 39 weeks and we haven't spontaneously gone into labor
we can schedule an induction and evict this kid if that's something you want to do and it's
really great for people who have other little kiddos they have to arrange child care for if
you take care of older parents and again need help coordinating care and different things like
that it's very helpful it is also really great for military families or spouses who travel in terms
of timing and getting things scheduled definitely a pro to be able to potentially schedule when
you're gonna try to bring that baby earth side so people ask me all the time you know what do you
think about elective inductions what would you do and my answer is that i love elective inductions
i love the arrive trial if like you feel that's what's good for you i personally knew that was the
right move for me i had my induction scheduled at 39 weeks i knew that if i was still pregnant
at 39 weeks i was going to evict that sweet little girl um and felt very confident that it
wasn't increasing my risk of c-section it was not um gonna do anything you know bad for babe and so
i was that was very much the right move for me in terms of it definitely gave you this like tiny
shred of feeling like you had control over this situation that you know yeah it also made it
pretty nice in terms of we both have pretty busy work schedules and for me to be able to tell
my colleagues like hey by this date i'm i need coverage so i can be home with sarah and baby
for those first couple weeks so that was like a nice little extra little bit of peace of control
in an otherwise uncontrollable situation yes and so while my water did break when i was elsewhere
i did not um kick into labor on my own nor was my cervix even remotely favorable at that point and
so i did get to experience some of those lovely things we talked about um i had a foley balloon
that my uterus did not like it all and tried to cramp it out um i got pitocin that sucked um like
that contractions were not a fun time so i was very grateful to have immediately accessible pain
meds when i was ready for those so so that's our overview of induction you all left us some amazing
questions on our community page about inductions hopefully we answered so so many of them with
this episode um we are going to go shoot a q a all about inductions just so this episode
doesn't get super long so please keep your eyes out for that um it was great having
you this week we are looking forward to more great content coming for you soon um
have a great week see you next week guys bye we're doctors but not your doctors
anything we've said in this video is for education or entertainment
purposes only it is not medical advice any specific medical questions you have
should be directed to your provider
