My guest writer for today’s post on the “Induction of Labor” is Debby Sapp. She is a Certified Family & Women’s Health Educator, Certified Clinical Herbalist, and a Doula. We have known each other since about 2011 when we were both taking the Naturally Healthy Herbalist Training course by Shonda Parker. In this article, she shares helpful information on two types of inductions.

Personal Story

Two of my children required inductions due to the medical reason of Premature Rupture of Membranes. The experiences were very different due the way the way they were administered. It is good to be aware of both types of induction and let that knowledge guide decisions during a baby’s birth.

Induction of Labor, By Debby Sapp

There is an appointed time for everything.  And there is a time for every event under heaven.

–Ecclesiastes 3:1, NASB

There are two types of inductions: those for specific medical reasons and those for elective reasons.  Inductions for medical reasons are done to protect the health of mother and/or baby.  Inductions for elective reasons are for convenience.  

MEDICAL REASONS for inducing have changed over the years.  

PROM (premature rupture of membranes):  In the past, birth attendants and moms often waited days after the water broke for labor to start.  Now, it’s common to induce within 12-24 hours after the water breaks, though there are many case histories of the amniotic sac sealing back up and the baby carrying to term or beyond.  The idea behind inducing for this is to prevent infection from having time to take hold.  Those who choose to wait it out work very hard to stay very clean (“hysterically hygienic”) and support the mom’s immune system with antimicrobial herbs.  If mom is within term dates, she may want to use herbs to stimulate labor, but if she is early, she may choose to use herbs to calm down the uterus and try to wait for better maturity for the baby.  

Postdates:  Going “pastdates” or “post-term” is now considered a medical reason to induce, though it was not uncommon in the past for moms to go past 42 weeks.  The true definition of postdates is one day or more beyond 42 weeks.  That assumes the actual dating of the pregnancy is accurate, however.  The idea behind inducing for postdates is to prevent “postmaturity,” (aka, a “dysmature,” baby) or stillbirth.  Babies who don’t deal well with labor (often termed “postmature” or “dysmature”) may be born before their due date and many babies born well after their due date may be perfectly healthy.  Part of the problem with the idea of “postdates” is that it was never scientifically set.  Some babies are born perfectly healthy at 37 weeks and some wait until after 42 weeks. The numbers vary as to how many women will reach 42 weeks, but it can be as high as 14% (SOGC).  Just reaching 42 weeks is not “postdates”- 42 weeks and one day is.  There are tests such as the non-stress test and the bio-physical profile to see how well the baby is doing which may give everyone comfort to carry on.

Perinatal mortality is a great fear of doctors and some midwives when it comes to postdates, but the research doesn’t support that.  

“A graph from 1987 statistics (Eden, Sefert) shows:

6/1000 at 38

2/1000 at 40

2.3/1000 at 41

3/1000 at 42

4/1000 at 43

7/1000 at 44”  (RUM: 39)

”Perinatal mortality does NOT [sic] double at 42 weeks; it rises almost imperceptibly and doesn’t show a steep rise until after 43 weeks, NOT [sic] 40 weeks.”  (RUM: 39) Though going from 3-4/1000 between weeks 42 and 43 is a 33% rise, the perinatal mortality rate at 43 weeks is still less than 38 weeks.  Some of the problems older babies may have can come from the very interventions meant to keep problems from happening.  “Interventions are risky,” as Carla Hartley often says.

Big baby:  Many a woman has been scared into having an induction with the words, “Your baby is getting too big.”  Babies are designed to be able to come through the birth canal and the birth canal is designed to accommodate a baby.  Women who’ve had cesarean sections because their baby were “too big” often go on to have a VBAC of a baby a pound or more larger.  When babies gain weight, they gain it proportionally; it’s not all in their heads or shoulders.  The best test of whether a baby is too big is let momma labor.  There were thousands upon thousands of big babies born before ultrasounds came along to tell us the babies were “too big.”  God knew how to design the process to work.

Miscarriage:  In the event a baby has passed, induction may be used to prevent medical complications for mom and/or for emotional reasons.  Some choose to wait it out; some choose to induce, either with herbs or medicine.  This is a situation where prayer for the family and support for their decision is important. 

ELECTIVE INDUCTIONS can be elective from the birth attendant’s or the woman’s perspective. 

“STOP,” or “Sick and Tired Of Pregnancy,” can be due to a woman’s common pregnancy little irritations not being given real support or due to lack of emotional support.  Not being able to sleep well is a problem the woman may need help addressing.  The woman may have heard stories of large babies and want to prevent that from happening.  She may hear, “Haven’t you had that baby yet?” so many times in a week that she thinks she can’t handle another one.  Coming up with a snappy comeback may help stop some of those comments.  Her birth attendant or doula may be able to give her ideas to support her last weeks of pregnancy.

Timing:  Both the birth attendant and the mom and her family may have reasons why they want the baby come sooner.  The baby isn’t in on this calendar preference, though.  We may know what’s happening right now that makes it seem like it’s a good idea for the baby to be born now, but God knows this baby’s future and how his/her birthdate may play a part in certain things that happen in their life. 

When we push for a baby to be born before mom’s body and baby’s body are ready, we’re interfering.  I encourage you to have a really sound reason for doing that.

SOURCES:  

RUM:  Research Updates for Midwives, Gail Hart, 2005, (page numbers from my personal numbering)

SOGC:  Society of Obstetricians and Gynaecologists of Canada 

Clinical Practice Guidelines, published March, 1997, pdf downloaded from the web.

Action

Thank you, Debby, for sharing this information with us. I echo your encouragement for pregnant mothers to carefully consider the use of induction for either medical or elective reasons. Trust God to bring the baby into the world at the right time.

May God bless your healthful endeavors!

Joni

P.S. What are your thoughts on induction?