Wondering if Low-Fluid Levels and / or a Big Baby Are Good Reasons to Induce?
At 40 or 41 weeks gestation, your provider might suggest that you have another ultrasound to determine the amount of amniotic fluid that is available for baby even though this measurement is a poor predictor of actual amniotic fluid volume. Many studies show that inducing labor because of a low fluid level does not have any beneficial effect on the outcome for mother or baby.
Doctors are concerned that a mother giving birth to a large baby will have trouble birthing the shoulders. About 8 in 100 babies near 9 pounds may need help from the doctor or midwife for their shoulders to be born. An induction or c-section does not reduce this risk. Read more about "big baby" inductions. Please note that the only way to really weigh a baby or measure is to do so after birth and not with an ultrasound.
The Gray Zone
Aviva Romm, MD is a certified nurse midwife and integrative physician. She is an herbalist and recommends a natural approach to healing that replaces or compliments pharmaceutical prescriptions of today's medical community. Aviva has authored many books on the subject of women's health and herbal medicine. She has an extensive blog, which shares her women's centered ideas and holistic remedies, proving her to be a pioneer of natural healing in obstetrical care. This article includes her suggestions for natural inductions and her opinion on "The Gray Zone" - medical "reasons" to induce labor such as "a big baby" and "overdue mamas". Aviva's website offers online courses for self-study of botanical medicine, called WomanWise.
Take control of your health and remember that medical doctors are human beings with special training (not special powers!) who may be consulted when considering your options and whose opinion may or may not be the advice you follow. Most medical doctors seem to push drugs and ignore alternative methods so you need to educate yourself and be confident in your care. The national average of medical inductions is over 23% and the World Heath Organization recommends no more than 10% of all births. Something's gotta give.
The Importance of the Bishop Score
If you allow your provider to perform a cervical exam at 40 and 41 weeks gestation, they are checking for your Bishop Score, which considers many factors to measure the likelihood of a successful induction. Some providers will strongly suggest an induction around 41 weeks gestation even if the Bishop Score is unfavorable to an induction of labor.
Determine your likelihood of a successful induction by assessing your score using this app available on iTunes. Have it ready on your phone prior to your doctor appointment so that you can ask the right questions and consider all options available to you for the birth of your baby.
Remember that many "overdue" babies are in a posterior position which does not cause the efficient kind of pressure on the cervix so that it can thin and dilate, and so the body wisely does not go into labor yet. Forcing the issue by inducing labor when the baby is posterior (or has other malpositions) tends to result in long, hard labors that often end in a c-section with longer postpartum healing and breastfeeding challenges.
Induction Triples the Risk for Cesareans in First-Time Moms
Here is the abstract of a recent study (Thorsell 2011) on how induction of labor increases cesarean rates, especially in first-time mothers with an unripe cervix.
In addition to the fact that a c-section is major abdominal surgery, there are many reasons to avoid one; longer postpartum healing, risk of later hospitalization, infection, difficulty breastfeeding, VBACs and future "trial of labor" scenarios, and much more. For specific information, and research data, please read on.
Safe Prevention of the Primary Cesarean Delivery
Read the recently published guidelines for the prevention of c-sections presented by ACOG.
The Risks of Stillbirth and Refusing an Induction
Many times a care provider frightens soon-to-be parents into inducing labor at 41 weeks by stating that there is a higher risk of stillbirth or fetal demise. Please read this study that shows there is a less than 1% chance of this happening if induction is refused and labor begins on its own prior to 42 weeks gestation. Please discuss this study with your care provider and together determine what is best for you and your baby's health.
The above article is a meta-analysis, it combines the results of many high quality randomized trials, where half the participants (all healthy women) were assigned to induction at 41 weeks gestation and the other half had expectant management (visits every 2-3 days) during the 42nd week.
The bottom line is that there was increased mortality in the group that was not induced - about 8 babies died (either from stillbirth or meconium aspiration) out of ~3000 births in the group that waited ("expectant"), and 0 babies died in the group (~3000 births) that was induced at 41 weeks.
This shows there is high quality data to support induction at 41 weeks, but the risks are small (~1/400) for infant death. Some patients are not willing to face that risk but others will find it sufficiently low to be willing to wait (risk is well under 1%).
You may wish to consider waiting a few extra days, if everything is ok with baby and mama, to allow the body to ripen naturally and prepare for a medical induction or to labor spontaneously prior to 42 weeks. It isn't helpful to fear the wait or the induction!
Ripen Your Body To Prepare for Induction
Maybe you've heard of Scalini's and the legend of their Eggplant Parmigiana? This dish is supposed to bring on labor. I say go and bring me some leftovers! Or make it at home and save me some. (You get my point, right?) Also, don't forget that what gets the baby in, gets the baby out. Plan for a special date night of dinner, massage, and sex - it's probably going to be the last evening like it for a while. :-)
Not only does massage help to relieve muscle tension but it also helps labor to begin by releasing oxytocin. When the body is relaxed and in a safe place, the natural hormone oxytocin is produced through physical touch and skin-to-skin contact. We recommend Renne Kimes and her staff at Pregnancy Massage Center in the Virginia Highlands.
In addition, visit Heavenly Foot Massage. The feet and ankles have multiple pressure points that can trigger labor! The good news is that everything you do to try to induce labor naturally causes the body to ripen and prepare for a medical induction. It all adds up and if baby and mama are healthy, each day that you wait to induce will make the medication more likely to work and help you have an easier labor and childbirth.
Labor Stripping / Sweeping Membranes
If you consent to a vaginal exam at the end of term, ask your care provider if they plan to also strip your membranes. Stripping or sweeping membranes can cause your uterus to become really irritable and contract irregularly. You may lose sleep because of painful contractions that are not part of early labor. Also, membrane sweeping/stripping can cause bleeding.
In this video, you will learn:
- The benefits and cons of membrane sweeping
- Why you have the right to informed consent/refusal with membrane sweeping
Many women report that nipple stimulation can cause labor to begin. This works by releasing the body's natural oxytocin and causing contractions. It works better when your cervix is soft and can comfortably be done using a electric breast pump. Using your hands can cause irritation and difficulties breastfeeding later on. Learn more about nipple stimulation here.
The release of endorphins and oxytocin initiates labor. We encourage our clients to visit Jim Gordon at Intown Acupunture in Oakhurst to receive his therapeutic prenatal treatments. MANY of my clients experience spontaneous labor after only one or two visits! Jim's calendar books quickly so if you're at 40 weeks gestation, you may wish to schedule an appointment to take place a few days before week 41 and again for a few days after.
Watch the video below to learn how to apply pressure to the key points on the body that can induce labor and create consistent contractions.