ARE 39 WEEK INDUCTIONS REALLY WORTH IT?

ARE 39 WEEK INDUCTIONS REALLY WORTH IT?

39 WEEK INDUCTIONS

In the most recent years, inductions have become more and more popular. I’m not talking about emergency inductions or having to get induced simply because baby and/or mom are in major distress — I’m talking about elective inductions. Meaning, more women are choosing to schedule an induction at 39 weeks simply because they want to. Whether it’s because they’re uncomfortable and want to get it over with or they would rather know what day it’s going to happen... Whatever the reason is, they’re happening a lot more.

​But is choosing an elective induction at 39 weeks in a healthy, low-risk pregnancy the best thing to do for you and your baby? Are there increased risks? Could you be more likely to end up in a c-section or use interventions like forceps, vacuum suction, or episiotomies? Could you have a longer, harder, and more painful labor, delivery, and recovery? We’re going to dig into it all.

FIRST, HOW ARE INDUCTIONS DONE?

There are several methods that doctors use to induce labor if it hasn’t started naturally. The ways to start labor include (source):

Ripening the cervix — this is done by medication and/or a tool that has an inflatable balloon on the end to help artificially widen the cervix.

Stripping the membranes — ​this is done by the doctor sweeping a gloved finger across the tiny membranes that connect the amniotic sac to the wall of the uterus. It may cause your body to release prostaglandins, which soften the cervix further to cause contractions.

​Oxytocin/Pitocin — a hormone drug that will be injected to you through IV. These hormones will help your uterus contract and will begin contracting within 30 minutes after being given. These contractions are stronger, more intense, and more painful than contractions in a natural labor. Risks of Pitocin include: overstimulation of the uterus, infection, rupture of the uterus, fetal distress, drop in fetal heart rate, and even fetal death (source).

Rupturing the amniotic sac — in other words, artificially breaking your water with the use of a special tool making a hole in your amniotic sac. This usually happens after you’ve been given oxytocin or Pitocin to help move things along. Usually, a woman will go into labor hours after their water breaks.

PICTURED BELOW:
1: Stripping the membranes
2: Rupturing the amniotic sac
3: Ripening the cervix with a balloon

RESEARCH ON 39 WEEK ELECTIVE INDUCTIONS.

I did some research and at first, I only read positive things about elective induction at 39 weeks. Apparently, it may lower the risk of c-section, preeclampsia, and gestational hypertension (source). But a lot of other studies had different outcomes that include other types of risks.

​Some studies showed that there was no difference in the amount of c-sections needed for an induced labor versus a natural labor, meaning that it’s possible a 39 week induction doesn’t lower your risk of a c-section (source).

​Other studies showed women who induced their labor spent around six hours more in the labor & delivery room than women who did not induce their labor, meaning they had a much longer labor and delivery. In fact, it can take anywhere between a few hours to three days to induce labor and have your baby (source). In addition, induction did not significantly reduce the chance of fetal death or serious complications in the newborn when compared to natural labor and deliveries (source).

​It is also known that induced labor can be more painful than natural labor. In natural labor, contractions build up slowly whereas in induced labor, contractions start more quickly and can be much stronger. In addition to this, your body may need interventions such as episiotomies, vacuum suction, or forceps since your body wasn’t naturally ready for this to happen, it was forced to happen (source). Using these types of interventions can cause a longer recovery time for yourself and bruising to your baby as well as possibly giving them a cone-shaped head for the first few days of their life if vacuum suction is needed. But there are other risks to inducing labor...

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OTHER RISKS WHEN INDUCING LABOR
(source)
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In about 25% of cases, women have to go on to have a c-section. Induction may not work for your body simply because it was not ready, causing you to go into a c-section where there are greater risks for you and you’re baby.

​Your baby might not get enough oxygen and their heart rate is affected from either how long progress is taking or because the contractions are too strong and too close together for your baby to handle.

You or your baby can get an infection.

Your uterus can tear or you may have to get an episiotomy (the doctor cuts you purposely to make room for baby, causing longer recovery) since your body was not physically ready for labor and delivery quite yet.

You bleed a lot more after birth (this may result in blood transfusions if you are losing too much blood).

REAL-LIFE EXPERIENCES FROM INDUCTION

Even after all the research I’ve done, I wanted to find out what induction was like for ordinary women in my community. I wanted to know if there were more negative experiences than positive ones before I really decided to go on with scheduling my 39 week induction.

Here’s what I found from my own research through surveys:

• 48% of women were glad they chose induction while 52% said it wasn’t their best decision.
• 22% of women ended up having a c-section after choosing induction while 78% ended up delivering vaginally.
• Out of the women who had to use interventions after choosing induction, 42.5% had get an episiotomy, 15% had to use forceps, 23.7% had to use vacuum suction, and 18.7% had to use more than one of those interventions, meaning an episiotomy and either vacuum suction or forceps.
• When asking hundreds of women about their thoughts on elective induction at 39 weeks versus letting labor naturally happen, majority of women thought it was best to wait until labor naturally happens.
• When asking hundreds of women about their experience when they decided to induce at 39 weeks, most said it was very long, painful, and/or that it was not a pleasant experience whereas a few said it was a great experience and rather quick.
• When asking hundreds of women how long their induced labor was, most women took 20 hours to 3 days. A lot of women took 15 to 19 hours. A small amount of women took 9 to 14 hours. And lastly, the tiniest bit of women took 8 hours or less.

WILL I GET A 39 WEEK INDUCTION?

At my 38 week prenatal appointment, I mentioned to my doctor how uncomfortable I’ve been. I explained to her how horrible my pelvic pressure and knee pain was. I went on and on about how hard it is to even walk at certain times of the day. Then, she asked me a question that caught me off guard — “Are you ready to schedule a 39 week induction?” I was taken back a little simply because I didn’t realize how real that option was. Like, I could choose to have my baby girl on December 26th if I wanted to. How cool?!

At first, I was like why not? I was telling myself all kinds of things to convince myself it’s the best idea. I’ll know when it’s going to happen... It will lower my anxiety levels... I get to meet her sooner... Everything will be planned... I’ll be more in control...

After doing some research for a couple days, I decided I will not be scheduling a 39 week induction. Although a lot of new studies show that it could be more beneficial to both baby and mom to induce at 39 weeks in a low-risk pregnancy, there is still a chance I’d set myself up for a longer, harder, and more difficult labor, delivery, and recovery. I already feel that I won’t handle a regular labor and delivery, let alone a harder one.

Personally, I’d like to just see how it all pans out naturally. I feel that putting my body through all these artificial techniques just to force it to go through something it’s not ready to go through is not the best idea. Having to be injected with hormonal drugs, making a hole in my amniotic sac with tools, placing balloon-like tools inside of me to thin out my cervix, and sweeping membranes from the amniotic sac and uterus just to force my body to start something it’s not ready for just doesn’t sit right with me unless it’s medically needed to be done in order to prevent emergencies. I realized that my discomfort and pain wasn’t severe enough to put my body through all of these things where, on top of all that, I could end up with a longer, harder, and more painful labor, delivery, and recovery.

THE TAKEAWAY

The takeaway from all of this is that, yes, elective induction at 39 weeks could put you out of your misery one or more weeks prior to going into labor naturally. Yes, elective induction at 39 weeks could lower rates of c-section, preeclampsia, and gestational hypertension.

However, elective induction at 39 weeks could also increase your risk of a longer, harder, and more difficult labor, delivery, and recovery. Epidural would only take away some of the pain of the contractions but does not take away the longer length of labor you could experience or the difficulty you may have delivering your baby due to induction. It could increase the chances of using interventions such as forceps, vacuum suction, or episiotomies, which can cause longer recoveries for mom and bruising/cone-heads for babies. Some studies also found that there was no difference in c-section rates as well as reducing risk of fetal death or newborn complications between women who induced at 39 weeks and women who went into labor naturally. Some studies found that induction can cause your baby distress during labor and delivery (not enough oxygen and affected heart rate) as well as cause problems like infection or uterus tears and excessive postpartum bleeding, leading to blood transfusions.

If elective 39 week inductions are available to healthy, low-risk pregnant women, is there really a need to force your body to do something it’s not ready for with a list of techniques and interventions just because it may reduce the risk of c-section (while other studies said there was no difference), preeclampsia, and gestational hypertension? You and baby are already healthy if you are being offered this early induction — could the potential risks turn your healthy pregnancy into a difficult labor, delivery, and recovery with all the tools and interventions that will most likely be needed? These are things to weigh and think about before choosing to schedule a 39 week induction at the end of your healthy pregnancy.

From real-life experiences, most responses and outcomes were negative towards elective induction rather than positive. However, 48% of women actually said they were glad they chose induction, considering their own use of interventions and length of labor. This could be because of confounding variables (other factors) like pain management, such as epidural. Being able to take the epidural early on in induction will help the pain of the quick, intense, and strong contractions that induction gives you. However, it does not lessen the time you spend laboring or lessen the chance of needing interventions that cause a longer and harder recovery.

Overall, a 39 week elective induction in a healthy, low-risk pregnancy has its risks, just like anything else. All women are different, including their bodies. Some bodies will react well to induction and it could be a breeze whereas other bodies might progress much slower and end up using interventions (causing longer, harder recoveries) or resulting in a c-section. In some cases, other bodies might reject induction altogether. It simply depends on your body and how it will react. The best thing you can do is discuss with your doctor if induction is right for you. Also, consider all the research, real-life experiences, and weigh your options. Do not take induction lightly! It may be the best thing you’ve done or it could be something you put your body through that you totally regret. You won’t know until you go through with it... So it’s not something you just schedule blindly. Take all things into consideration.

WHAT ARE YOUR THOUGHTS?
Do you think it will be worth going through a 39 week induction, for whatever reason you see fit, and to just see how it goes for your body? Or do you feel that it’s safest to just wait for your body to go into labor and progress naturally, without any use of medical tools to artificially force your body into labor? Considering the possibilities of a longer, harder, and more painful labor, delivery, and recovery? Even if epidural is your go-to (it sure is mine), is it worth being in a long labor that may use several interventions to deliver your baby and causing a longer recovery? Not to mention the risks during the induction process? Are those chances you’re willing to take? Let me know your thoughts in the comments below!