Approximately 20% of pregnant women don’t go into labor on their own and, therefore, need to be given medicine in the hospital to start labor and help avoid the increased risks with pregnancies that are prolonged past the due date. The most current literature indicates that pregnancies continued beyond 39 weeks are associated with increased risks for:
- Severe Neonatal Complications
- Meconium Aspiration Syndrome
- Mechanical Ventilation
- Birth Trauma (bone fractures, brachial plexus palsy, intracranial hemorrhage, facial nerve injury). Also increased risks to the mother like 3rd and 4th degree lacerations which occur through the rectal sphincter and rectum.
- Shoulder Dystocia
- Neonatal Seizures/Encephalopathy
- Neonatal Sepsis
- Depressed Apgar Scores/Fetal Acidosis
A simple, yet proven rule of pregnancy is the longer a fetus stays inside the uterus, the larger it gets. It, therefore, shouldn’t surprise you that pregnancies which are allowed to continue past the due date are generally associated with higher rates of complications. The larger the infant, the greater the chance you will need to be delivered by cesarean section- placing you at greater risk of infection, bleeding and other complications associated with these types of surgeries.
Dr. Walker and Dr. Shakespeare have had among the lowest cesarean section and complication rates in Bakersfield. The average cesarean section rate for all obstetricians is currently about 34%. Our cesarean section rate has always been lower than 20% and is currently around 15%. Patients don’t often understand or realize that one of the more important factors determining whether they will have a cesarean section or not is what the cesarean section rate of the doctor is who they have chosen. You may walk into another doctor’s office in Bakersfield and have greater than twice the risk of delivering by cesarean section simply by choosing that doctor to deliver your baby. One of the reasons we have such a low cesarean section and complication rate is that we prefer not to let our patients go past the due date.
The literature has shown that the environment within the uterus actually starts deteriorating after 37 weeks. The placenta starts getting more calcified and the amniotic fluid decreases. These changes result in greater chances that there will be abnormal fetal heart rate patterns during labor which in turn result in greater chances that a cesarean section will be performed.
There are some physicians who have the policy of not offering or recommending induction to their patients until they are over 41 weeks gestation. This results in higher cesarean and complication rates.
Patients are sometimes reluctant to be scheduled for induction of labor prior to appropriate counseling because they think this might be associated with an increased risk of cesarean section and be more painful. Our experience proves that inducing patients sooner rather than later does not increase the risk of cesarean section. It is, in fact, a significant factor in our ability to have some of the lowest cesarean section rates over the last two decades. An occasional patient is sometimes reluctant because she thinks that her body, specifically her uterus, knows when it is time to go into labor. This is not true. The uterus is not aware of the increased risks to you and your baby by not delivering by your due date and does not have the ability to know when it should start contracting.
There has been no proven difference between the subjective perception of pain with induced versus spontaneous contractions. Studies that have measured the pressures and intensity of contractions (by placing catheters inside the uterus) have shown no difference between induced and spontaneous labors.
In our experience, the only consistent downside to being induced is that you are in L & D longer due to the obvious fact that you don’t arrive at the hospital in labor. But if you take into account the decreased risk of cesarean section, your overall hospital length of stay will be less since patients who deliver vaginally go home sooner than those delivered by cesarean section. Since it sometimes takes greater than 12 hours or more for a patient being induced to get into active labor, it can be frustrating during those early hours. But if you consider the benefits to you and your baby by decreasing the above risks and complications with induction, those frustrations are put into proper perspective.
Dr. Walker and Dr. Shakespeare make every management decision regarding your pregnancy and delivery based on what is best for you and your baby. There is no personal or financial benefit to us by scheduling labor inductions. We prefer that our patients go into spontaneous labor, and fortunately, most of them do. However, a certain percentage of pregnant women for some unknown reason, don’t go into spontaneous labor, and it is those women who benefit from earlier induction. There is nothing that a pregnant woman can do that has been proven to consistently make her uterus start contracting and go into labor. We do not recommend that you try any of the wives’ tales or superstitions that pertain to a pregnant woman’s ability to stimulate labor.
Our recommendations for when and how to schedule induction of labor are based on evidence based data and sensible, best practice guidelines that have been perfected through years of experience. Please ask us if you have any questions about labor induction and inform us if you disagree with our recommendations.