Why Not Schedule It?

It seems to make more sense in a lot of ways: your doctor or midwife may not be on call when you go into labor, your mom wants to buy her plane ticket, your office wants to plan for your absence, you’re worried about your water breaking while you’re in line at the post office. . . And now there are drugs to induce labor so that you can just set the date. Plus, maybe you’ve heard that it won’t really make a difference.

But there is a difference. A few differences, in fact. First, we know from scientific research that the baby participates in the initiation of labor. Scientists haven’t yet mapped out exactly how it works, but the baby seems to hormonally signal the mother’s body when its lungs, the last organ to develop, are mature. In other words, the baby comes when the baby is ready — to breathe.

The lung maturity concern also applies to women weighing the pros and cons of scheduled repeat cesarean, which usually happens around 38-39 weeks: babies are more likely to have respiratory problems when they are born early or without labor. That means more admission to the Neonatal Intensive Care Unit, more difficulty bonding and breastfeeding, and a higher chance of the baby developing asthma.

What will an induction mean for you? If you induce, you’ll be admitted to the hospital and will most likely spend the next 24 hours of labor confined to bed. Because staff will need to kickstart and maintain contractions and dilation with drugs like Pitocin, Cytotec, and Cervidil, they will require IV fluids and continuous fetal monitoring. At that point you’ll very likely want an epidural, because Pitocin contractions are more painful, especially when you can’t move around. A director of OB/GYN in New York City called Pitocin without an epidural “cruel and unusual punishment.”

Pitocin, given to more than half of women during labor, is the synthetic preparation of the hormone oxytocin, the driving force of labor that causes the uterus to contract. You know the soft side of oxytocin already: it floods your body during orgasm, when you fall in love, when you get close to a friend, even when you sit down to a shared meal. It is the hormone of connection, closeness — love. And when women give birth, they get the biggest helping of oxytocin that humans ever experience. A “love high,” if you will.

Pitocin replicates oxytocin’s muscle, producing strong uterine contractions, but it does not pass to the brain. You don’t get the warm and fuzzies with the pharmaceutical version. Furthermore, it shuts down your body’s own oxytocin production. That means that when you get Pitocin in your IV — whether you’re being induced or just “augmented” — you’re missing out on the natural oxy-rush.

How does Pitocin affect the baby? Not enough research has been done. But we do know this: when your uterus contracts, the baby and umbilical cord essentially get a squeeze, and little oxygen passes through to the baby until the contraction is over. Labor is essentially sprint-training. Spontaneous labor generally starts off slow, allowing you and the baby to get acclimated. Pitocin, on the other hand, takes you from zero to 60 all at once. Your body’s contractions start slow and build; artificial contractions can hit like a gale force wind. And if staff are not careful, they can be too strong and last too long — the technical term is hyperstimulation — causing the baby to be deprived of oxygen. Most babies turn out fine, but some don’t. Consider this: in nearly half of malpractice suits involving damage to the baby, synthetic oxytocin is cited as the culprit.

The old adage “let nature take its course” is generally the most medically sound advice you could hear when it comes to labor. Inductions don’t always work, and what’s started by drugs must often be finished by the surgeon’s scalpel. You are twice to three times as likely to end up with a cesarean section if you induce.

If you’re considering a medically unnecessary induction, think about whom it will really benefit. While it may seem more convenient to just book it, think of the inconvenience of recovering from major surgery, or waiting for your baby to be released from a NICU — two very real possibilities. And think also about the increased risk to your pelvic parts of a pushed birth. Again, the best, healthiest option for both you and your baby is labor that your body starts on its own, progresses on its own, and concludes on its own terms.