Wait for Labor to Start on its Own

Assumption: Spontaneous labor is better for mother and baby, if no complications are present during pregnancy.

This study of women with low-risk pregnancies and no complications demonstrates that elective induction (inducing labor without medical cause) and elective cesarean surgery (cesarean without medical cause) can lead to more adverse outcomes than waiting for labor to begin on its own.  In the case of induction of women with no prior births, they were 2.7 times more likely to have an unplanned cesarean.  First time moms and those who had given birth before were both more likely to have postpartum complications.  Women who had prior births and chose to have cesarean surgery were more likely to have postpartum complications.  Rates of NICU (neonatal intensive care unit) admission and administration of oxygen for the baby were elevated in women who chose cesarean surgery.


My Views:
I am not surprised by these results.  The timing of labor is set by the baby’s readiness to be born and if the baby has not yet given the “signal” to the hormones that start labor, it makes sense that the baby would need more care and may not always be completely ready for birth.  It also stands to reason that the body would not be at its most efficient if it is not ready to go into labor.  A woman’s body starts preparing for labor some time before the labor actually starts and if it has not had time to go through the changes and preparations needed, labor could reasonably be more difficult and not progress as smoothly.

Pitocin: Friend or Foe?

Assumption: Pitocin is good for labor because it speeds things up, making birth more pleasant and less dangerous for everyone.

While it may speed labor, birth is harder and more dangerous when synthetic oxytocin is used.  This study from New Zealand measures the use of synthetic oxytocin and the outcomes of births that use it versus births that do not use it.  The study shows a marked increase in the need for/use of pain killers, instrumental delivery like vacuum and forceps, and cesarean surgery.  There was also an increase in neonatal morbidity in cases where synthetic oxytocin was used.


My Views:
I understand that there are very good reasons to use Pitocin to induce or augment labor.  Situations like these are not the norm, however.  Unfortunately, many low-risk women with no medical problems are being induced for the sake of convenience.  There is a reason that studies of birth certificates show a huge discrepancy between births occurring Monday through Friday during “work hours” and those occurring on weekends and “after hours.”  If you have a weekend baby, you are in the minority!  I think the medical community is starting to see the problems these early scheduled inductions are causing and is slowly shifting inductions from 38-40 weeks to 41 weeks, which is a good start.  Still, I feel that women are not told of the risks they are taking by not waiting for labor to start (or continue) on its own.

Pitocin and ADHD

Assumption:  Pitocin (the drug used to induce labor) has no effect on the baby.

A study released this year found pitocin use by mothers was a strong predictor of ADHD (diagnosed later in life) in children.  67.1% of children whose mothers has been induced with pitocin were later diagnosed with ADHD.  35.6% of children whose mothers were not induced with pitocin were later diagnosed with ADHD.  In this study, pitocin effectively doubled the risk of an ADHD diagnosis.


My Views:
Wow.  I had wondered about this years ago as I watched so many children with ADHD in the schools.  I understand that genetics can play a role in such a diagnosis, but I find it fascinating that two of the things that have grown so much in recent decades (ADHD and pitocin use) can be linked.  This study makes clear that more research is needed and that parents need to be informed of this risk.  Fortunately, the newest recommendations for OBs includes waiting until at least 41 weeks to induce (without medical cause), which I hope will cut down on the number of inductions.