Worth the wait
Author: Sara Rider

Like so many things in life that are supposed to come naturally, having a baby can be more complicated than people anticipate. Particularly in the last weeks of a pregnancy, it can seem like your bundle of joy is never going to get here. And in many different situations, the words “induce labor” start to enter into the conversation. But when is induction a good idea – and when is it best to wait and let your new son or daughter show up when he or she is good and ready?

An individual situation
According to Mayo Clinic, a pregnancy is considered full term at 40 weeks gestation. But, particularly for first-time mothers, it may not be uncommon for the baby to arrive after the due date. In some cases, when the due date comes and goes, and still no baby, women may wonder if their physician should induce – a process involving medications or other techniques to start labor. But according to Mayo Clinic, a baby is not considered post-term until 42 weeks, so they advise delaying induction until 10 days after the due date.

“I think you have to tailor every case to the individual situation,” advises Dr. Clarissa Gutierrez, an OB/Gyn with Renaissance Women’s Group. Sometimes, induction is what’s best for mother and baby; other times, it’s best to wait.

“The common causes for induction are things like diabetes or hypertension,” explains Dr. Gutierrez. “A lot of the time, we monitor the growth of the baby. And if we’re ever concerned that the baby isn’t growing like the baby should, then it would be a reason for induction.”

According to Dr. Gutierrez, it comes down to “is the baby better off on the outside, being taken care of by pediatricians, or is it better off in utero?”

A time to be born
According to Mayo Clinic, new research suggests that babies born between 37 and 39 weeks can have medical problems that don’t occur in babies born after 39 weeks. These can include respiratory problems, seizures and jaundice. This increase in potential health problems can continue through the first year of life.

Dr. Gutierrez cautions that the situation is complicated by a shift in what is considered to be a full-term pregnancy.

“Fifteen or 20 years ago, women used to be induced earlier on in their pregnancies. It used to be considered that ‘term’ pregnancy was 37 weeks. Now we know that there is a lot of benefit to a couple more weeks’ pregnancy. We try to keep the pregnancy going until 39 weeks because we know that it decreases the baby’s chances of needing to be in the neonatal unit and it eases baby’s transition into the outside world.”

When it’s time to make a move
Even though those extra weeks may have health benefits, there are times when induction is the best choice for mother and baby. But induction comes with its own risks.

“Inductions can be linked to an increased risk of C-sections. So a lot of patients say ‘no’ when you mention induction,” explains Dr. Gutierrez.

“A lot of patients know that spontaneous labor is best, but if the baby is at risk, we try to encourage them to be induced. And it’s not just the baby that’s important – there can often be severe consequences for the mother if she is not induced.”

Dr. Gutierrez points out that not all inductions succeed. It may be necessary to try induction a second time, or the patient may end up needing a C-section.

“One of the things that’s very important in the decision is if the patient has already delivered before. There’s a big difference in terms of success for induction in patients who have already delivered vaginally. We know if the cervical exam is not favorable for an induction and if it’s the patient’s very first baby, those are big risk factors for a failed induction, which ultimately means a C-section.”

According to The American College of Obstetricians and Gynecologists, for labor to be successfully induced the cervix needs to begin to soften, thin out and open. Depending on where someone is in this process determines whether or not the cervix is ready for labor.

Asking for a scheduled
According to NPR, the number of women who had induced labor more than doubled between 1990 and 2006. In nearly a third of these cases, women who had induced labor had C-sections. The concern with women requesting induction – because of their own discomfort or for family or physician scheduling preferences – has led the March of Dimes to start a campaign called “Healthy Babies are Worth the Wait,” to discourage elective induction.

“It does happen sometimes that the patient wants to be induced, but the doctor doesn’t agree,” concedes Dr. Gutierrez. “The latter stages of pregnancy can be quite uncomfortable and the patient can want to be induced because of the discomfort of the last part of the pregnancy. We always have to be sympathetic to that, but we have to weigh what’s best for mom and what’s best for baby and make a decision with the patient’s input about what’s best for both.”

Asking the right questions
For women who are trying to decide whether to be induced – whatever their individual situations – Dr. Gutierrez recommends a candid conversation with your doctor.

“It’s a complicated situation when we try to estimate your chances of success for an induction,” admits Dr. Gutierrez. “I think that women need to know what the risks and benefits are. Your question should be, ‘is my baby safer inside me than outside?’ That’s the biggest thing for you to know and to discuss with your doctor.”

As long as baby – and mother – are safest waiting a little longer, avoiding induction and the risks of a possible C-section can be the best thing for everyone.

Sara Rider is a native Austinite who has worked with physicians and hospitals throughout Texas. She frequently writes freelance articles on health topics for newspapers and magazines.

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