What Childbirth Education Class Members Need to Know

Of the six Lamaze International care practices that support normal birth, #1 is Labor begins on its own.  What do our class members need to know?

1.       Risks of all inductions (Goer, Leslie, & Roman, 2007)

• Labor ends in a cesarean birth 2 – 3 x more frequently.
•  Increased need for pharmacologic pain relief.
• Higher likelihood of requiring neonatal resuscitation.
• Possible increases in instrumental vaginal delivery, intrapartum fever, shoulder dystocia, low birthweight, and admission to the neonatal ICU

2.       What the trend is nationally, and what to expect locally.

• 2006 National induction rate:  34% of all live singleton births (Declerq, Sakala, Corry, & Applebaum, 200s)
• 2006 Great Starts Survey:
  • Evergreen:        30%  (Evergreen Midwives:  14%)
  • Overlake:          25%
  • Swedish:           No data submitted
  • Stevens:             25%
  • UWMC:            50%  (UWMC Midwives:  19%)
  • GHC:               23%  (GHC Midwives:  15%)
  • Ballard:             20%  (Ballard Midwives:  <5%)
• CIMS and WHO recommend an induction rate of <15%

3.       Why we induce labors:

• Clear medical indications: <3% of inductions.  IUGR, GDM, PIH, prolonged ROM, very low amniotic fluid.Electively, either for parents’, care providers’, or hospitals’ scheduling convenience.
• "Soft” indications.  There may be some medical benefits but not enough evidence to clearly recommend induction.  Parents must be careful about choosing induction for soft medical reasons and balance the potential or unknown benefits with the clear risks of induction.  Soft indications include:

Suspected large baby.  Class member considerations: 

• How accurate are ultrasound predictions of baby’s size?
• What are ACOG’s guidelines for induction for suspected macrosomia?  http://www.aafp.org/afp/20010701/practice.html

Post 40 weeks:  Class member considerations:

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  • When do the benefit of induction outweigh the risks?  Probably not before 42 weeks gestation (or 41 completed weeks of pregnancy).  See Cochrane citation below. 
  • How accurate is my due date?  CBEs can find more information here to help class members understand when babies are likely to arrive and the accuracy of their due dates.  http://www.transitiontoparenthood.com/ttp/birthed/duedatespaper.htm

4.       How might induced labors feel different from spontaneous labors? Adapted from Simkin’s “Seduction of Induction” presentation.  http://www.pennysimkin.com/acticles/Seduction_of_Induction,_2-05.pdf  

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  • “Hurry up and wait” 
  • Unclear when baby will be born.  Need for cervical ripening, unforeseen hospital scheduling can be discouraging and disorienting and directly opposite from the controlled, planned date some parents have in mind.
  •  Possible fasting before and during induction.  How well can you run a marathon without continuous nutrition?
  • Must have continuous monitoring.
  • Must have an IV.
  • Possibly feeling like more of a sick patient than an able, well laboring woman.  Unique emotional and physical challenges.
  • Possibly more labor pain earlier in the process.
  • Possibly longer labor.

 Gülmezoglu AM, Crowther CA, Middleton P. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD004945. DOI: 10.1002/14651858.CD004945.pub2