Induction of labor, through the use of swiping membranes, breaking the water and the use of Pitocin, along with other methods are at times useful ways of helping labor along, under the right circumstances. The American Congress of Ob/Gyn's official stance is to not induce labor before 42 week, unless dictated by additional risk to mother or baby to continue the pregnancy. They also maintain that elective induction before 39 weeks carries a greater risk of complications during delivery and risk to the baby being pre-mature or a "late-preemie". That being said here is a great article about what to ask if your doctor suggests inducing.
There is just one question they did not cover and that is "What is my Bishop score?". Your Bishop Score is a thirteen point system looking at various factors, such as how effaced, how dilated, and the position of the baby. If your Bishop Score is less than nine, it considered not favorable for induction. You would have a higher risk of induction failing and having to have an emergency c-section, because your body was not ready for labor.
Induction of labor is a way that either by strong medications or physical means (pitocin, amniotomy, forcible dilation, etc.) that we attempt to cause labor to begin and the baby to be born. Sometimes this is needed before the baby and body are ready because of illness in the mom or baby, but many times it is simply done because it can be done. Since induction, as with any other procedure, can carry risks, it’s best to wait when possible. Here are some questions to ask before agreeing to an induction:
- Why do I need an induction of labor?
This question is tied very closely to: Are my baby and I healthy? Knowing why an induction is being recommended is the first step in having this discussion with your provider. This is where you can try to figure out if you and your baby are experiencing complications or if your practitioner thinks that they are offering you an option that is for social reasons (tired of being pregnant, doctor on call, doctor has vacation soon, your family can schedule, etc.). This also opens the conversation up to other possible alternatives or helps you understand when induction might be the best option.
- When is my due date?
Ask this question to remind both you and your practitioner where you are in pregnancy and when your due date is actually. There is a lot of data out there that talks about how these last weeks of pregnancy are crucial to your baby’s developing brain and lungs. Even though your baby might not go to the intensive care unit, you might see more difficulties with eating, breastfeeding, breathing and potentially even learning disabilities later. If you aren’t yet 39 weeks and you have no medical conditions, waiting is the best option.
- Are there other alternatives, including waiting?
Your practitioner might say that there are other alternatives, including testing of some sort, perhaps a biophysical profile or non-stress testing (NST). These can also help buy you time to get to 39 weeks if you are before that date. This might be a good alternative for some families.
- What percentage of mothers in your practice get induced?
While this doesn’t specifically have to do with your pregnancy, it does give you a clue as to the practice statistics. If large numbers of women are being induced, you might ask yourself and the practitioner – is this about me or your practice? If you ask this question early enough in your pregnancy or before pregnancy, it might be a red flag that sends you for a second opinion or a new doctor.
- How will an induction change my birth plans?
Since there is more than one method of induction, you’ll want to discuss what methods your practitioner is thinking about. This will include avaginal exam to figure out what your cervix is doing. A measurement called the Bishop Score will tell your practitioner what methods of induction are likely to be more successful. (There's also an app for that!) A low Bishop score indicates that you are more likely to have a cesarean birth than a vaginal birth. You will also want to know how it affects your mobility, your need for fetal monitoring and about any time limits that might be placed on your labor.
In the end you may decide to wait, you may decide to schedule the induction but further away or you may agree to an induction. The key is having the discussions with your practitioner and knowing that you are making the right decisions for you and your baby.