Pregnant and tired? Don’t induce labour till you read this!

Published: November 7, 2013
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Elective inductions should ideally be avoided. Unfortunately, a large number of inductions today are by choice because “By the time they reach 37 or 38 weeks, a lot of patients are frankly sick of being pregnant.”

The minute I began showing with my first child, I was subject to horror stories about labour. I don’t know why, but there is something about a swelling belly that triggers an impulse in every woman to share crazy, sometimes obscene and often exceedingly horrific labour stories.

I still remember going out for lunch with friends and leaving my meal untouched, as ugly tales involving forceps and vacuums unfolded. At my baby shower, the hottest topic of discussion was lengthy labour, and although I later encountered opposition to the epidural, some friends at the shower made it seem as if the pain-killing injection deserved mention in the United Nations’ Charter of Rights.

As I entered my third trimester, I felt myself being pulled in opposite directions, with one friend recommending squatting exercises to push the baby lower, while another suggested that I rest as much as possible in order to ensure that nothing went wrong in the last couple of months.

Then, just when I thought that I had seen and heard it all, the dreaded ‘P’ word began making rounds.

What is induced labour?

I was in my 38th week when I happened to mention to my doctor that my mother had been unable to go into natural labour.

She looked at me from over the top of her pince-nez glasses and said, thoughtfully,

“Hmmm, really”

I nodded, laying a gentle hand on my belly as if to instruct the baby to be good and to help speed up labour. The doctor, in the meanwhile, had started to scribble furiously in her writing pad, her pony tail bobbing up and down.

“Well, you know that these things are sometimes genetic, and if your mother has had problems, chances are that you will too.”

I swallowed the knot that had started to form in my throat. I was really not sure where this conversation was going, but I did not have a good feeling about it. Sensing my anxiety, she patted me on the back and continued cheerily,

 “It’s nothing that we can’t fix, though. Some Pitocin and you should be opening up like a flower.”

She had said it: the dreaded ‘P’ word.

Pitocin is a liquid medication that is a synthetic form of the naturally occurring hormone, oxytocin. It is used to induce labour intravenously. I thought in dismay, that almost eight out of my 10 mommy friends had undergone induced labour.

Emily Oster, gives more credibility to my casual survey in her book, Expecting Better, where she writes about a huge rise in induced labour in the last couple of decades.

She writes that in 1990, fewer than 10% of births were induced medically, while by 2009, the number had risen to 25%. Moreover, this increase occurred across the board and not only for babies who were overdue. In addition, in 1990, only seven% of births were induced at 39 weeks of pregnancy, that is full-term, but by 2009 induced deliveries at the same stage had risen to 23%.

What are the risks of using Pitocin?

Theoretically, it seems that inductions are not a bad thing. After all, if the body isn’t entering labour on its own, then a little push can’t do any harm, can it?

Unfortunately, there seems to be some evidence to the contrary.

Recently, labour inductions were linked to autism, particularly in male children. However, autism isn’t the only reason I would recommend that you ask your doctor a few questions if Pitocin comes up. In recent years, many women have reported that their doctors seemed overly eager to induce them, often for no reason other than to speed up labour.

When I was 40 weeks pregnant, my doctor began getting the jitters – and in turn, gave them to me. Although my stress tests were normal, she scared me by saying that the tests don’t remain very sensitive once you cross the due date. This was enough to shock me into compliance and although my mid-wife insisted that all was well and that the baby would come when it was ready, I just couldn’t handle the stress. Eventually, I ended up telling my doctor,

“Pump me up with all the Pitocin you want!”

However, I soon realised that much of what studies say about Pitocin is true.

The instant the drug began entering my body, the pain began shooting up. It took all my energy to stop myself from biting my husband’s hand, screaming at the top of my lungs and kicking at the bed.

My doula (a non-medical person who assists a woman before, during, or after childbirth, by providing physical assistance and emotional support) kept begging me to breathe, but I could barely wheeze! Then, when I finally managed to gasp out a few coherent words, it was to yell for an epidural – although I had sworn to myself that I would deliver my baby without any medication.

Later, I learned that most women who opt for an induced labour, report much higher levels of pain than those who undergo natural labour. My doula explained it to me in this way:

 “When you induce labour, you are pushing the body to do something that it isn’t yet ready for. On the other hand, in natural labour, the body slowly and gradually gears up to push the baby, and hence, the pain increases slowly and steadily, which is why women are able to bear it better.”

Apart from the pain, induced labour also increases the risk of delivering the baby through a C-section. Both my sisters-in-law opted for Pitocin on their doctors’ insistence, and ended up undergoing surgeries when they had been hoping for natural births.

However, the most alarming factor in induced births is that a baby born through an induction at 37 weeks is bound to have a lower Apgar score (a method of measuring the baby’s health at birth) than one born through natural labour.

Although the difference is slight, it is seemingly alarming enough for the American College of Obstetricians and Gynaecologists to warn that elective inductions should not be performed before 39 weeks.

When should labour be induced?

Does this mean that all inductions should be frowned upon?

No, of course not. An induction is a good option if the mother or baby’s health is being compromised by a prolonged pregnancy. However, elective inductions should ideally be avoided. Unfortunately, a large number of inductions today are by choice.

Sabine Droste, MD, an associate professor of maternal/foetal medicine at the University of Wisconsin, Madison, holds the patients as responsible as the doctors for this trend. According to her, many elective inductions are done on the insistence of patients. She says,

“By the time they reach 37 or 38 weeks, a lot of patients are frankly sick of being pregnant.”

So, all those mothers-to-be who are considering induced labour, I would urge you to make an informed decision and ask the following questions:

“Is there any harm in waiting for spontaneous labour to begin?”

“Is induction absolutely essential for the health of the baby?”

“Will I be in any danger if I choose to wait for labour to kick in naturally?”

If the answers to the above questions are ‘No’, then it is perhaps better to stay away from Pitocin and allow nature to take its course.

Have something to add? Share your pregnancy stories with us at [email protected]

Ayesha Nasir

Ayesha Nasir

A journalist and writer based in Islamabad. She has previously worked for the national in Abu Dhabi: time.com and the daily times. She tweets @talkatease (twitter.com/talkatease)

The views expressed by the writer and the reader comments do not necessarily reflect the views and policies of The Express Tribune.

  • Javeria

    Very Informative… thanks for sharing such a write up… Thumbs upRecommend

  • Faraz Talat

    I’m not sure why so many patients fear an epidural more than the pain of delivery itself. It’s a safe, time-tested procedure. The side effects, other than an occasional headache, are so rare they’re seen only in surgical textbooks these days.

    It’s understandable why artificial induction is more common than necessary: after week 38, frazzled mothers can sometimes be found scolding their fetuses and cursing their allegedly “lazy’ uteri. And some doctors do seem to take advantage of these women’s eagerness to “get it over with”.

    But I don’t think it’s cause for too much alarm. Remember, at some point, we’re weighing the risks of induced labor against the risks of not having a timely delivery.Recommend

  • Nadia

    I was induced at 40 weeks because my waters broke and contractions wouldnt start at all even 36 hours later. But I agree, forcing the body to do something it isnt ready for is definitely not the right option. Induction only gave me horrible pain and contractions every 2 minutes – but no dilation! So it only made things worse!Recommend

  • Afshan Aziz

    I am nowhere near pregnancy, but this is one good read! Thank you.Recommend

  • Citizen

    such a informative write up . ET sometimes you do a good job ! yes i am being sarcastic .Recommend

  • Engineer

    I was given induced labour when i was pregnant with twins. Never thought of asking the dr about reason may be it was because of the placental insufficiency shown in reports.
    We should ask the drs. nice readRecommend

  • Chipo Shukula

    While this article makes a good point, lets not carried away as this isn’t a medical perspective. Each pregnancy and labour is different and usually doesn’t conform to any kind of pre-planning. Inductions should be reasonably prescribed by doctors. An increase in autism spectrum disorders reported after induced labors is also prevalent in cases where mother’s are taking epidurals (even in natural births). Let inductions be discretionary and medically relevant where needed.Recommend

  • Saadia

    oh epidural is of no use. ii had epidural with my baby but it had to bear pain :)Recommend

  • Ayesha Nasir

    You know in Pakistan, doctors are way too eager and enthusiastic about inducing labor. I think part of the reason is that doctors are over-worked and deliveries is an extremely lucrative profession.Recommend

  • Ayesha Nasir

    Yes: When I was pregnant with my third child, I was going over due. But the doctors in the US had no issues waiting a week or more before trying to nudge my body. Here I have commonly seen inductions even before the 40 weeks of a pregnancy.Recommend

  • Ayesha Nasir

    But the interpretation of “medically relevant” varies vastly depending on the doctors in question! In America, medically relevant means waiting for 42 weeks before opting for an induction. In Pakistan sometimes medically relevance can translate into an induction at 38 weeks.Recommend

  • Ayesha Nasir

    Maybe yours was a unique case Saadia! The epidural definitely helps greatly, at least that’s my experience.Recommend

  • Ayesha Nasir

    Yes: Asking the doctor. Getting a second opinion. Raising relevant questions. All these are key to making a good and medically sound decision.Recommend

  • Ayesha Nasir

    Completely agree Faraz but often there is no need for an induction! My point is simply that we need to raise questions whenever a doctor suggests an induction.Recommend

  • Ibti

    A very guiding n informative piece of write up indeed!
    The desision of either getting an induction or epidural or for that matter volunteering for a C- section haunts a mom-to-be the whole trimester and even before. In Pakistan, the fear of getting mishandled by the so called certified n well qualified doctors lurkes our senses.
    Doctors here are indeed over worked hence dwells into hasty decisions by reciprocating to the woman’s so natural instinct to ‘get over with it’!!!
    I was diagnosed with CPD( cephalopelvic disproportion) way before my trimester began and that too without any internal examination.
    So much for medical relevant revelations!Recommend

  • Ayesha Nasir

    Ibti. Surprisingly after my first internal pelvic exam, the mid wife told me I would never be able to have a normal delivery and had severe CPD. I changed the doctor, asked the right questions and mash allah I have been able to have three normal deliveries.Recommend

  • Naila

    I will definitely second it as my sis had induced labour with her baby girl in USA and a year after her birth she became autistic.As far as thing r concerned over here in Pakistan no doc will bother to discuss this matter with mother to b n if that poor woman dares to express her knowledge on such matters she will b accused of having layman knowledge.Recommend