Induction of Labour - why are we in such a hurry?

“When will this baby come??” Perhaps the most commonly asked question by pregnant women, especially those excitedly waiting for their first child to arrive. It is so hard to be patient when the shopping has been done, the picture-perfect nursery has been put together and the appointments have been attended.

Spontaneous labour starts when all of the right stars are in their proverbial alignment. This post is about non-spontaneous labour and the use of artificial means to encourage labour to begin and babies to be born. There have been many comments and discussions in the past about the safety, efficacy and necessity of using induction tools such as synthetic oxytocins or prostaglandins to artificially begin the childbirth process. Recently I have read two separate articles about induction; both with very different arguments for NOT putting a mother into labour unnaturally.

The first article I read was actually in the Globe and Mail on Wednesday, June 24th, 2009. It was titled: “Babies’ IQs suffer with fewer than 39 weeks in womb, study finds,” and it outlined some of the research of Dr. Michael Kramer of McGill University in Montreal. The findings of his which were the focus of the Globe article indicate that while babies are considered to be “full term” at 37 weeks gestation, perhaps there are small, but potentially significant advantages to the infant if gestation were able to continue beyond the 37 week mark.

The first advantage he notes relates to the research he and his associate, Seungmi Yang presented at a conference in California in June which refers to the slightly higher IQ rates of babies born at 40 weeks. His measurement was not significant in the overall intelligence of the child (1.7 points) however he notes that this wasn’t a small group they were studying (some 18,000 participants) and these were the resultant findings. These findings alone are enough to make a parent say, “hmm.”

Other research he has done, this time with collegue Xun Zhang, reflects the reality that the closer to 40 weeks gestation a foetus is at the time of birth, the greater the chance for the survival of that child. The article goes on to describe that these same children “also had an increased chance of neonatal seizures or other problems shortly after birth.”

Kramer acknowledges that there is “a low absolute risk of infant death at [37 – 39 weeks] gestational age.” Despite this however, “the risks were more than 50 percent higher at 37 weeks than at 40 weeks.” However, as worried expectant parents, wouldn’t we do everything we can to protect our unborn children from any potential harm that may befall them?

I will go on record here to remind you that I don’t think that most care providers are being reckless or are unnecessarily taking chances with our unborn children when they recommend inducing labour before 40 weeks gestation. In fact, I would argue that the most responsible midwives and obstetricians I have met have, in reality, gone out of their way to educate their expectant mothers about the value of baby gestating as long as the baby requires. Usually it is the moms-to-be who lack the patience to let their labours begin when it best suits both mother and baby. In my experience, when care providers suggest labour must be started artificially and early there is a strong medical reason for it.

This is just the first of the two articles I read though. Let me tell you a little about the second. It is more of a description of the circadian rhythms of the human body and how everything seems to line up surrounding birth. In fact the article was about the role oxytocin plays in the circadian cycles of mice and I won’t get into that here. What I want to highlight is from what Coturnix has written about the times of day when women go into labour.

He writes:

There are two aspects to timing of birth. The first one is the determination how long the pregnancy will last, i.e., on which day the birth will occur. The second one determines at what time of day the labor will start. The first is not dependent on the circadian clock (e.g., this is not affected by lesions to the suprachiasmatic nucleus, SCN), while the second one is determined by the circadian clock. In all mammals studied to date, there is a strong circadian control of the timing of birth, likely related to the safest time of day for that particular species. . . . I think I remember that majority of human births (especially in more primitive societies without artificial light, epidurals, Caesareans and induced labor) occurs somewhere around dawn.

He goes on to write, “the current understanding is that the first one - duration of pregnancy - is determined by the fetus, while the second one - time of day of labor - is determined by the mother.”

When we add this last statement into consideration with the findings of the research by Dr. Kramer then there appears to be even further evidence that the foetus would prefer to stay inside the womb until such a time presents that he or she is ready to be born. Sometimes it is simply information such as this, which helps an expectant mom dispel some of her anxieties over when the process will begin. Sometimes she is willing to step aside and let the baby decide.

Between you and your care provider you will determine what to take from research such as this. The point of me taking some time to put my thoughts out into the “blogosphere” is simply to offer you a few reminders as to why it is okay to stay pregnant a little while longer. I know the ankles get puffy, the hips hurt and the trips to the toilet are infuriating at times. Savour this time though. It won’t be long before you have to share your baby with several other people and this private and intimate relationship you and your baby have created will change forever. You **will** miss being pregnant. Don’t rush it to happen too soon.

Posted by Sam