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induction

Why one mother says induced labor isn’t a good idea

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A new study recently came out linking autism to labor induction. I will not get into the weeds right now on that particular study, but it got me thinking again about labor induction, a topic that I cover at some length in “Expecting Better.”

When I was 39 weeks pregnant, my doctor offered to schedule an induction at my due date. This is common now, although that wasn’t always the case. In 1990, fewer than 10 percent of births followed medical induction of labor; by 2009, this number had risen to 25 percent. This increase has occurred across the board, not just for babies who are overdue. In 1990, only 7 percent of births at 39 weeks of pregnancy were induced, but 23 percent were induced by 2009.

Sometimes, labor is induced for medical reasons — the baby isn’t doing well or a condition threatens mom’s health. This, obviously, makes a lot of sense, and we are lucky to have the option. But this wasn’t the case for me; my doctor was effectively offering an elective induction: I could choose to have the baby at 40 weeks, rather than wait for her to arrive on her own. And by 39 weeks I was definitely tired of being pregnant, and Penelope was plenty big. But still I said no, and here are the two reasons why.

First, the use of pitocin — the primary method of induction — may increase pain in labor. For anecdotal evidence on this all you have to do is go online: Chat boards are full of women who have had spontaneous labor and an induction and report the latter was more unpleasant. My mother had three children, all without an epidural, and reported that labor after she was induced with my youngest brother was the worst, despite the fact that he was the third kid. Going beyond anecdotes, researchers find that women who are induced with pitocin are more likely to use an epidural; increased use of pain relief probably points to increased pain (at least before the epidural is administered!).

Second, there is both direct and indirect evidence that induction can increase the risk of a cesarean section. This seems to be most true when pitocin is used alone. Of course, C-sections are safe and common, but recovery from them still tends to be harder than recovery from a vaginal delivery.

These concerns are there for any induction — before or after 40 weeks. I was even more wary of pre-due-date induction. Some women like this idea — 37 weeks is full term, so why not get the baby out already? — but it is really not smart if not medically indicated.

It is true that babies who come on their own at 37 weeks do pretty much just as well as those who arrive on their own at 40 weeks. One good way to measure this is with something called the Apgar score. This is a number from zero to 10 that measures how well your baby is doing at birth — about 80 percent of babies get an Apgar of nine or 10, which means the baby is doing well, and a score of seven or below typically indicates some distress.

Among babies born on their own — no induction — at 37 weeks, about 2.4 percent of them have a low Apgar score. Among those born on their own at 40 weeks, this is about 2.3 percent; the difference is very small. But when we look at induced births, we see slightly larger differences. For babies induced at 40 weeks, again the share with low Apgar scores is 2.3 percent, but for babies induced at 37 weeks, it’s about 3 percent. This difference is small in magnitude but statistically significant.

This basic point is consistent with something that the American College of Obstetricians and Gynecologists has been saying for a long time: that elective inductions should not be performed before 39 weeks. Basically, some babies are ready at 37 weeks, but that does not mean they all are.

Does this mean you should say no to an induction for medical reasons? No. But it may mean that it’s a good idea to stick it out for a few more days, to give your kid a chance to arrive on his or her own time.

By Emily Oster, Slate

 

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Comments
  • comment avatar Anissa August 26, 2013

    this is pretty scary. i was induced with one of my children and though it’s just a study without too much proven at this point, it makes me not want to do it again.

  • comment avatar Kris August 26, 2013

    Actually, Emily isn’t entirely correct in some of her statements. We are finding that 37 week infants don’t necessarily do as well – they tend to have more feeding issues, for one thing, and may even be more prone to developmental issues. Their little brains were meant to develop without external demands for the full 40 weeks. It seems that those with spontaneous onset of labor early on are fine, it’s those we induce for convenience who tend to struggle.

    Unfortunately, Emily also has a huge error – Apgar scores have zero reflection on an infant’s readiness for delivery, at least for the long term issues like feeding and neurodevelopment that are much more important. Apgars reflect nothing more than the infant’s tolerance of labor and delivery, period. They are only meaningful in knowing whether a baby was “depressed” at delivery, and how they responded to any resuscitation efforts.

    (I have been in obstetrics since 1985, and a neonatal nurse practitioner for 8 years.)

  • comment avatar Erin August 26, 2013

    Mine was induced, but for medical reasons, at 40 weeks. I did not have pitocin nor an epidural.

  • comment avatar Alaina August 26, 2013

    Lots of preliminary information that draws a focus to the fetal / post natal environment and the influences it has on child development.

    This time point is a particularly vulnerable developmental window as both large leaps forward and intense activity culminates in both genetic expression, immunological processes and neurogenesis.

    This then can set a further abnormal pathway in infants throughout their life span.

    As to this quote…

    And that points to induction and augmentation as useful in these situations, not as problematic, and certainly does not affirm them as a risk.

    “The findings of this study must be balanced with the fact that there are clear benefits associated with induction and augmentation of labor,” said study author Chad A. Grotegut, M.D., assistant professor of obstetrics/gynecology at Duke Medicine. “Labor induction, especially for women with post-date pregnancies or medical conditions such as diabetes and high blood pressure, has remarkably decreased the chance of stillbirth.”

  • comment avatar Barker August 26, 2013

    Incidentally, my wife and I have had three children. We had labor induced for the third child only. He is now 9 years old and autistic. I have never suspected that inducing his labor had anything to do with his autism. This new study has done nothing to persuade me otherwise.

  • comment avatar Dance August 26, 2013

    Five out of six births in this study did not involve either induction or augmentation, according to the data. And if these are happening without real medical indication–and that’s a frequent claim–then the likelihood of there being a socioeconomic infuence seems even higher, in my mind. The rate of c-sections can be in large part attributed to a huge increase in elective procedures.

    It might not be “beyond reasoning,” but it’s beyond any implications of an OR of 1.13 or so.

  • comment avatar Amy August 26, 2013

    Autism affects one in every 50 U.S. children. Among boys alone, it’s one in every 31.

    It should bother people that as numbers continue to soar, there is officially no known cause or cure for autism. Autism is treated as a curiosity. Every week there is a new guess about the cause—and it’s usually linked to the behavior of the mother.

    The links show autism connected to pollution, maternal antibodies, and vitamin deficiencies. Add to that, older moms, moms who marry older dads, moms who drink, moms who smoke, moms who take antidepressants while pregnant, moms who have babies too close together, moms who have babies that are too small or too big, and moms who live too close freeways, and you pretty much have it. We are not far removed from the “refrigerator moms” of 50 year ago. These cold, unfeeling mothers caused their children’s autism. Today, it’s still the mom’s fault.

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