Labor can be damned inconvenient. It commences when it will — and that can mean at some very inopportune times: when the doctor is out of town, for instance, or when the husband is away on a business trip or the Thanksgiving meal spread out on the table, or the mother-in-law too busy to lend a hand.
Back in 1990, fewer than 10 percent of pregnancies culminated with induced labor, but these days, up to 55 percent of all pregnant women in the US choose to have labor induced at some expedient, pre-scheduled time. While labor sometimes needs to be induced to ensure maternal or fetal safety — such as when the fetus grows too large or when the mother has an acute illness — at least half of all induced labors have nothing to do with medical necessity; they’re simply the product of doctor/patient preference.
Dr. Dana Stone, an obstetrician/gynecologist at Lakeside Women’s Hospital in Oklahoma City, says in an article in the Oklahoman, “[Elective induction is] becoming more and more accepted. People’s lives are so busy. So much of having babies and taking care of babies is unpredictable — [women] kind of like to predict as much as they can.”
But the choice to schedule labor has as much to do with physician schedules as it does with their patients preferences. It’s a big help to physicians to be able to organize their work schedules around civilized hours instead of getting the midnight call, in spite of the fact that the American College of Obstetricians and Gynecologists discourages elective induction except when it’s medically necessary. Certainly, a cursory web search brings up plenty of pages indicating that induced labor is perfectly safe; but dig a little deeper and a world of proven risk factors appears — enough to provoke the FDA and the Physician’s Desk Reference to discourage voluntary induction.
According to studies, induced labor increases the likelihood of cesarean delivery by two to three times. As an article in Childbirth Instructor Magazine points out, “Problems with inductions stem from two sources: the physiology of initiating labor and the side effects of the procedures and drugs.” In order to “ripen” an unready cervix, patients typically receive prostaglandins, which can over stimulate the uterus, causing violent labor, with intense pain for the mother and distress for the fetus. There’s also an increased risk of uterine rupture and severe bleeding. Labor averages nine hours in a first-time pregnancy when the cervix has been dilated sufficiently, but when dilation is induced, labor averages 22 hours.
When the cervix is ready but contractions haven’t started, induction involves steps such as manually rupturing the [membranes], which increases the risk of abnormal fetal heart rate and maternal infection. Ideally, rupturing will bring on labor, but if it doesn’t, the woman will most likely be given the drug oxytocin, which strengthens contractions. The potential complications include severe maternal pain, extended labor, increased maternal bleeding, blood loss, jaundice, and greater likelihood that pain drugs and epidurals will be administered and that forceps or vacuum-assisted delivery will be necessary. And again, when these complications occur, there’s a greater chance that cesarean will become necessary. The bottom line is that sometimes convenience can turn out to be damned inconvenient.
Look, nature has ensured that in most cases, labor begins when both fetus and mother are ready — when the cervix has dilated, when the fetus has finished developing, when the mother’s body is biologically prepared — and as the astrologically inclined would say, when the stars are in alignment. Forcing the process can lead to ramifications that far outweigh the convenience — not to mention wrecking havoc with your child’s astrological charts.