The conflict my clients have with their providers most frequently
The most frequent conflict I see my clients having with their providers is about: (drum roll please) recommended induction of labor.
There are many medical reasons a doctor might recommend induction - including gestational diabetes, blood pressure, cholestasis, oligohydramnios, fetal growth restriction, placental abruption, infections, etc. But the friction I am talking about happens to clients who do not have these risk factors. They are recommending induction for being close to or past their due dates usually due to a suspected big baby or risks of complications just based on their length of gestation. It is almost guaranteed for clients who have OBs as their providers that their doctor will recommend an induction at 39 weeks gestation. I think it makes sense to discuss it with pregnant people during this time, but many of my clients are desiring a less medicated labor and have already communicated this to their providers. Providers will often not take this into consideration when talking to them about labor induction. They might reference ultrasounds showing how big the baby is and how this increases risks during labor and birth. Some providers will go as far as to schedule an induction date without buy in from the patient. Evidence based birth has an article on inducing for “big babies” https://evidencebasedbirth.com/evidence-for-induction-or-c-section-for-big-baby/
The rate of inductions of labor have been increasing. Per the CDC, in 1990 the rate of induction of labor was 9.6%, in 2011 it was 23.2% and in 2020 it was 31.4%. These numbers also include those who are being induced for medical reasons, but I think the increases in the numbers are due to the increases in inductions for low risk, or non-medically necessary inductions. One of the reasons that more providers are pushing 39 week inductions is that there was a study called the ARRIVE trials which came out in 2018 that has caused many providers and facilities to increase their rates of “elective” induction.
The hard thing about planning inductions around the estimated size of a baby or weeks of gestation is that both those things have a range of uncertainty. For estimating the weight of babies using ultrasounds in later pregnancy, the range of uncertainty is +/- 15%. Also when estimating someone’s due date at the start of their pregnancy, drs go off of the date of your last menstrual cycle (not knowing the exact date of conception which could have happened anywhere within a period of a few weeks) and an early ultrasound which has a range of uncertainty of +/- 5-7 days. Also, the gestational length varies from person to person based on genetics and other factors.
Knowing this, I want us to keep in mind, we don’t know when the actual due date is or how big your baby is. Your doctor doesn’t know when your actual due date is. It’s an educated guess with a range of uncertainty. Also, if you are past your due date, there are ways to check that you and your baby are still doing well.
The reason one would like to avoid an unnecessary induction is that especially for first time moms without starting without any cervical change, induction is a tough experience. If you are trying for a birth without pain medication or with a lowered chance of a cesarean, an induction is a substantial complication.
If you agree to an induction, it comes with:
Almost guaranteed IV port placement from when you arrive at the hospital
Guaranteed continuous fetal monitoring
Clear liquid diet (how strongly this is enforced depends on the facility and nurse)
Being admitted to the hospital, which is a place that can feel foreign and uncomfortable and you will have many disruptions to your normal rhythms of sleep while uncomfortable things are strapped to your body.
It’s a process that routinely lasts 24-36 hours but it could be up to 5 days after you’re admitted until your baby is born depending on availability of staff, resources, and how well cervical ripening works
Again, some inductions are medically indicated and unavoidable. If this is you, you can work with your birth team to figure out how to embrace this and prepare. Waiting for birth can also be very stressful and choosing to induce because then you will know when your baby will be here because you know that will cause you less anxiety is also a valid choice.
Also, if you have birthed before or have some cervical change already (see bishop score https://perinatology.com/calculators/Bishop%20Score%20Calculator.htm), those are indicators that your induction may go smoother and quicker.
Medicine has come a long way to try to mimic the workings of the body but it really isn’t the same. Allowing your body to do as much of the process on its own tends to lead to things going smoother and more effectively. Inductions tend to be longer and more tiring because you can be going without good food or sleep, being hooked up to uncomfortable apparatuses in a more uncontrollable environment. And then you still have to labor and birth.
My desire is not to scare anyone or to shame folks for making the choices they have made. What I want is for people to understand that they are able to choose and not let a pushy provider take that choice away from you. Again, a due date is an educated guess that could be up to a week off, baby’s size is a guess with a +/- 15% uncertainty. And there are ways to check to see if the birthing person and baby are still healthy and doing well. If you are a birthing person and feel like you could use more help and support, please reach out to others who are going through the same thing or think about hiring a birth doula. I’d love to hear what you all think!