{"id":28490,"date":"2018-11-22T11:39:00","date_gmt":"2018-11-22T19:39:00","guid":{"rendered":"https:\/\/www.avawomen.com\/?p=28490"},"modified":"2019-07-15T11:06:00","modified_gmt":"2019-07-15T18:06:00","slug":"induce-labor","status":"publish","type":"post","link":"http:\/\/www.avawomen.com\/avaworld\/induce-labor\/","title":{"rendered":"Inducing Labor\u2014What Does The Latest Research Say?"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">Inducing labor is increasingly common these days, but it wasn\u2019t always this way. Not too long ago, doctors were hesitant to intervene until quite late in pregnancy. Today, you\u2019ll find the internet is full of tips for inducing labor naturally, but are they effective? (And more importantly\u2014are they safe?)<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Here, we\u2019ll give the full scoop on what the latest research says about inducing labor, what it means for you, and what you can expect if you learn you\u2019ll need to be induced.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Key Takeaways:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">It\u2019s usually best to go into labor on your own. (But in some cases\u2014such as when the baby is in distress\u2014this is just not possible.)<\/span><\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">If your doctor is concerned about your level of amniotic fluid, make sure to stay well hydrated and ask for what&#8217;s called a &#8220;deep vertical pocket&#8221; test.<\/span><\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Of the &#8220;natural&#8221; methods for inducing labor, the most effective is nipple stimulation and what&#8217;s known as &#8220;sweeping the membranes,&#8221; a procedure your doctor can perform during a cervical exam.<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h2><span style=\"font-weight: 400;\">What does it mean to induce labor?<\/span><\/h2>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">Before we go lumping all inductions into the same bucket, it&#8217;s helpful to know that there are two different types of inductions: those that are recommended for a medical reason (like when your doctor suspects that the baby is in distress) and those that are not. Inductions that are not executed for a medical reason are called elective inductions. This type of induction has become increasingly common in recent years. (And while you&#8217;re getting prepped for labor, check out our post on the <a href=\"https:\/\/www.avawomen.com\/avaworld\/stages-of-labor\/\">stages of labor<\/a>.)<\/span><\/p>\n<h2><\/h2>\n<h2><span style=\"font-weight: 400;\">How are inductions performed?<\/span><\/h2>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">There are two different ways that inductions are performed:<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400;\">If your cervix has already begun to soften and dilate, your doctor will likely give you a drug called Pitocin to start <a href=\"https:\/\/www.avawomen.com\/avaworld\/what-are-contractions\/\">contractions<\/a>. Pitocin is a synthetic version of oxytocin, which is a naturally occurring hormone in the body that helps your uterus contract during labor.<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li style=\"font-weight: 400;\">If your cervix has not begun to soften and dilate, your doctor may give you the Pitocin drug as well as either a prostaglandin drug like Misoprostal\u2014which will soften the cervix\u2014or something called a balloon catheter to stretch out the cervix.<\/li>\n<\/ul>\n<h2><\/h2>\n<h2><span style=\"font-weight: 400;\">Why are inductions so much more common today?<\/span><\/h2>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">In 1990, only <a href=\"https:\/\/www.cdc.gov\/nchs\/products\/databriefs\/db155.htm\">10% of births<\/a> were medically induced. But by 2010 that percentage had ballooned to <a href=\"https:\/\/www.cdc.gov\/nchs\/products\/databriefs\/db155.htm\">23.8%<\/a>. Why the sharp increase? One factor is medical malpractice lawsuits. Another is that obstetrics has become much more consumer-driven, so some women request inductions simply for the scheduling convenience. But in recent years, organizations like the March of Dimes and the American College of Obstetricians and Gynecologists have been pushing to reduce the rate of early elective deliveries.<\/span><\/p>\n<p>&nbsp;<\/p>\n<h2><span style=\"font-weight: 400;\">What are the guidelines?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The <a href=\"https:\/\/www.acog.org\/Womens-Health\/Labor-Induction?IsMobileSet=false\">American College of Obstetricians and Gynecologists<\/a> now recommends that induction is used before 41 weeks <\/span><i><span style=\"font-weight: 400;\">only<\/span><\/i><span style=\"font-weight: 400;\"> when medically necessary\u2014for example, when a mother develops hypertension or her water breaks, but labor does not begin.<\/span><\/p>\n<p>&nbsp;<\/p>\n<h2><span style=\"font-weight: 400;\">What is the problem with inductions?<\/span><\/h2>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">It\u2019s been pretty widely believed for a while that inductions increase the cesarean section rate. But some researchers weren&#8217;t so sure about the veracity of that assumption, because it was based on older medical research. So in 2018, these researchers organized a study of more than 6,000 women at the National Institute of Child Health and Human Development to test the theory. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">Surprisingly, <\/span><a href=\"https:\/\/www.ajog.org\/article\/S0002-9378(17)32491-2\/abstract\"><span style=\"font-weight: 400;\">that study <\/span><\/a><span style=\"font-weight: 400;\">found that the cesarean section rate actually went down among women who were induced. (The rate fell from 22% among women who weren&#8217;t induced to 19% among women who were.) This study also found that there was no major increase in complications among women who were induced. This study counters the long-held belief that induction <\/span><i><span style=\"font-weight: 400;\">increase<\/span><\/i><span style=\"font-weight: 400;\">s the cesarean section rate. Even though this 3% change is relatively small, the study&#8217;s author Dr. William Grobman pointed out that reducing the overall cesarean section rate is extremely important, so even a small percentage drop is significant and benefits women&#8217;s health overall.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Another <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22696345\"><span style=\"font-weight: 400;\">study<\/span><\/a><span style=\"font-weight: 400;\"> also found that being induced at 41 weeks or more resulted in slightly better outcomes (fewer perinatal deaths and cesarean sections) but pointed out that the absolute risk for perinatal mortality was small. But some organizations (like as the March of Dimes, for example) are skeptical of these results and caution that women should still evaluate the overall pros and cons of induction.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The takeaway? Whether or not to be induced is not a black-and-white decision. It&#8217;s more like a grey zone that depends on your specific case, and you should talk to your doctor.<\/span><\/p>\n<p>&nbsp;<\/p>\n<h2><span style=\"font-weight: 400;\">When are inductions necessary?<\/span><\/h2>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">If you\u2019re worried about the possibility of getting induced\u2014and hoping to avoid it\u2014there are a few situations in which it may be necessary for the sake of your health and that of your baby. But it\u2019s important to be aware of the latest research and, when necessary, to self-advocate. \u00a0Here are the cases in which your doctor may suggest an induction, whether or not it&#8217;s in your <a href=\"https:\/\/www.avawomen.com\/avaworld\/create-birth-plan\/\">birth plan<\/a>:<\/span><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">If you\u2019re past your due date, there are some risks that your placenta may begin not to function optimally, which means that your baby may not be getting enough oxygen and nutrients. The risk of stillbirth also increases at this point.<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">If your water breaks before contractions begin.<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">If you\u2019re having any complications like gestational diabetes, hypertension or preeclampsia.<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">If your amniotic fluid is low, or the baby otherwise seems not to be tolerating pregnancy well, which can be assessed from what&#8217;s called a &#8220;nonstress test&#8221; that your doctor may ask you to take. <\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">The takeaway? While it\u2019s best to deliver on your own in most cases, there are some situations in which induction is the better call. Your doctor will talk to you about your specific situation and will run some tests to see how your baby is doing.<\/span><\/p>\n<p>&nbsp;<\/p>\n<h2><span style=\"font-weight: 400;\">How do you induce labor naturally?<\/span><\/h2>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">According to everything from a Wikipedia entry to folklore from centuries ago, there are supposedly natural ways to encourage your baby to come out\u2014acupuncture, sex, walking for miles, or inhaling teas and tinctures. But you should look at each of these suggestions with a skeptical eye. (Most of them have little to no supporting scientific evidence.)<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Here are some of the suggestions you\u2019ll find on the internet. And according to <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21524953\"><span style=\"font-weight: 400;\">this study<\/span><\/a><span style=\"font-weight: 400;\">, here&#8217;s what the research says about the effectiveness and safety of each method.<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Castor and primrose oil\u2014Not only are these oils <em>not<\/em> effective in starting labor, but they may actually increase the likelihood of complications. <\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Sex\u2014This one actually is based in science, as semen contains something called &#8220;prostaglandins&#8221; that soften and ripen the cervix. But <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11406072\"><span style=\"font-weight: 400;\">this study<\/span><\/a><span style=\"font-weight: 400;\"> found that the role of sex in starting labor is uncertain. <\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Breast stimulation\u2014There is some evidence to support that this method is effective (and it is clearly safe). Specifically, <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5813971\/\"><span style=\"font-weight: 400;\">this study<\/span><\/a><span style=\"font-weight: 400;\"> found that breast stimulation for 3 days (15 minutes per session for a total of one hour per day) was effective.<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Red Rasberry tea\u2014This is an old (mid)wive&#8217;s tale. It&#8217;s been suggested over the years based on traditional knowledge, not <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21524953\"><span style=\"font-weight: 400;\">scientific research<\/span><\/a><span style=\"font-weight: 400;\">\u2014which merely suggests that it <\/span><i><span style=\"font-weight: 400;\">may<\/span><\/i><span style=\"font-weight: 400;\"> be beneficial, but the jury is still out.<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Acupuncture\u2014Clinical research is mixed. Some studies (such as <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19922252\"><span style=\"font-weight: 400;\">this one<\/span><\/a><span style=\"font-weight: 400;\">) have shown that it may be beneficial while others have shown that has no effect. <\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Blue cohosh\u2014This is plant root was used traditionally by Native Americans to induce labor. But it can be harmful and should not be used in pregnancy\u2014as it may cause defects in the baby or toxicity in the mother.<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Stripping the membranes\u2014(Warning: this is not something you can do by yourself!) During a cervical exam, your doctor can detach the bag of water from your uterus. It usually works, and women who have their membranes stripped are 25% more likely to go into labor. <\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h2><span style=\"font-weight: 400;\">What are the risks of inducing labor?<\/span><\/h2>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/www.ohsu.edu\/xd\/research\/centers-institutes\/evidence-based-policy-center\/evidence\/med\/upload\/Elective-Induction-of-Labor_PUBLIC_RR_Final_12_10.pdf\"><span style=\"font-weight: 400;\">Research<\/span><\/a><span style=\"font-weight: 400;\"> has shown that elective induction (induction without an apparent medical reason) before 39 weeks increases risks for babies including:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Breathing problems<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Infections<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Being admitted into the NICU (Neonatal Intensive Care Unit) <\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h2><span style=\"font-weight: 400;\">How do I know if my baby is tolerating pregnancy O.K.?<\/span><\/h2>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">There are two main tests that doctors use to see how well the baby is faring: a nonstress test (otherwise known as a cardiotocograph or CTG) and measuring amniotic fluid levels. But the reality is, <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21353089\"><span style=\"font-weight: 400;\">research<\/span><\/a><span style=\"font-weight: 400;\"> has shown that these tests have some limitations. According to<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/3421253\"> this <\/a>study,\u00a0<\/span><span style=\"font-weight: 400;\">there is considerable variability in how the nonstress test is read\u2014making false negatives ( as well as false positives) possible. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">In the nonstress test, (NST) you&#8217;ll be hooked up to a fetal monitor for about 20 minutes. Your doctor will be looking to see if the baby is moving around as he should be, as evidenced by variations in his heart rate. However, if the baby is asleep, his heart rate will be consistent and won&#8217;t be accelerating the way it would if he were awake. In order to make sure that your baby is awake, your doctor may clap or have you drink sugar right before your test. But there is <\/span><a href=\"https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0884217515332494\"><span style=\"font-weight: 400;\">no scientific evidence<\/span><\/a><span style=\"font-weight: 400;\"> to justify that using juice in this instance is effective.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Something known as a biophysical profile (BPP) offers a more complete picture of how your baby is doing, as it includes a nonstress test in combination with ultrasound. The ultrasound will check for:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Fetal breathing <\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Fetal movements<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Fetal tone<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Amniotic fluid volume<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h2><span style=\"font-weight: 400;\">How do I know if I have enough amniotic fluid?<\/span><\/h2>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">Low amniotic fluid, a condition called \u201coligohydramnios\u201d is a real and serious concern. If there\u2019s not enough fluid, the umbilical cord can become compressed, cutting off nutrients and oxygen to your baby. <\/span><\/p>\n<p><a href=\"https:\/\/www.elsevier.com\/books\/obstetrics-normal-and-problem-pregnancies\/gabbe\/978-0-323-32108-2\"><span style=\"font-weight: 400;\">Research<\/span><\/a><span style=\"font-weight: 400;\"> has shown that babies of mothers with low fluid volume have higher mortality rates and are more likely to spend time in the NICU. So if your fluid is low, your doctor will want to run some other tests (such as the nonstress test) to learn more about how the baby is doing. And if the results of that test show that the baby is under stress, then induction is recommended.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">But, a low fluid reading on its own (something called \u201cisolated oligohydramnios\u201d) is not necessarily a problem, as long as the baby is doing well otherwise. Though it is common for inductions to happen in this case, there is <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19191776\"><span style=\"font-weight: 400;\">little evidence<\/span><\/a><span style=\"font-weight: 400;\"> that justifies being induced in this case. In fact, research has shown that when low amniotic fluid is not accompanied by other indications of fetal distress, the babies do just as well when left alone to come out in their own time. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">There are also a couple different ways to measure amniotic fluid:<\/span><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">One is by measuring the total fluid volume (or AFI).<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Another is by measuring what\u2019s called the \u201cdeepest vertical pocket.\u201d<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">Imagine your uterus is a lake, with some deep sections and some shallow sections. The AFI measures the total amount of water in the lake, while the deepest vertical pocket measures the deepest section, which is really the only one that matters. So the deepest vertical pocket test will still tell you if there\u2019s a problem, but it is more likely to exclude those situations in which there is no reason for concern. <\/span><\/p>\n<p><span style=\"font-weight: 400;\">Research has also shown a pretty simple (and obvious) intervention for low fluid\u2014drinking water! \u00a0<\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11869566\"><span style=\"font-weight: 400;\">This study<\/span><\/a><span style=\"font-weight: 400;\"> found that when women drank two liters of water before their ultrasound, their amniotic fluid level increased. <\/span><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Inducing labor is increasingly common these days, but it wasn\u2019t always this way. Not too [&hellip;]<\/p>\n","protected":false},"author":10017,"featured_media":29338,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[781,36],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v17.3 (Yoast SEO v18.8) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Inducing Labor\u2014What Does The Latest Research Say? - Ava<\/title>\n<meta name=\"description\" content=\"ACOG recommends that induction are only used before 41 weeks when medically necessary. 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