Follow the directions on the box: Early elective induction is not a good idea

The Pediatric Insider

© 2011 Roy Benaroch, MD

Doting Dad: “So, how do you like your birthday cake?”

Dubious Daughter: “Um….it’s OK, I guess. Why is it so runny?”

Doting Dad: “Oh, the box said cook it for 30 minutes, but since we’re in a hurry I took it out of the oven early. Here, have a spoon!”

Dubious Daughter: “Um….mom??”

Pregnancy is a mysterious process. We’re pretty sure we know how it begins, but we honestly have no idea why women go into labor at 40 weeks. How the baby (or mom) knows it’s time to begin labor, we don’t know.  But it seems to work out if we let labor begin on its own without second-guess the timing. Of course, there are some circumstances where for the health of baby or mother, it’s best to start labor early. But most of the time, a hands-off policy (remember, we’re talking about the end of the pregnancy here) works out just fine.

But what if you’re in a hurry, or you want a colorful 11-11-11 birthday for Junior?

Leave it to humanity to not leave well enough alone. A growing number of pregnancies seem to be ending in “elective inductions” on dates chosen for all kinds of reasons. That might be OK, if the baby’s allowed to stay in the oven long enough. But many of these pregnancies are being electively induced prior to 39 weeks gestation. And it turns out that babies born even a little too early may have some serious (and preventable) health problems.

As reported in the Wall Street Journal, growing evidence of the harm of the not-quite-term elective delivery is leading to a push back against these early inductions of convenience. Babies born prior to the natural gestation of 39 weeks have more problems with feeding, and are more likely to have difficulty breathing. They’re more likely to need a prolonged hospital stay, and more likely to have permanent health consequences of their complications such as hearing or vision loss. They have an increased risk of psychological and learning issues, perhaps stemming from inadequate prenatal brain development. While most babies born a week or two early will do fine in the long run, many will not—and we can’t tell before the baby is born if these problems are likely to surface.

There are sometimes legitimate health reasons to delivery a baby early. But without a specific medical reason, early elective induction prior to 39 weeks poses an unacceptable risk to the long-term health of your baby. It’s better to follow the directions on the box. You’ve waited 37 weeks–another few weeks is worth the wait for a healthy baby. Let the pregnancy end when it’s supposed to, and enjoy years of tasty, well-baked birthday cake together.

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4 Comments on “Follow the directions on the box: Early elective induction is not a good idea”

  1. Rob Lindeman Says:

    WSJ? Anybody can read the paper. Why don’t you analyze and interpret the primary literature for your readers?

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  2. Dr. Roy Says:

    Dr. Lindeman, sorry to disappoint you with the lack of academic rigor in this post. Feel free to stick around, or read some old posts– you’ll see that sometimes I write about items from the primary literature, sometimes I lazily review news items, and sometimes I just make stuff up that I think my readers will enjoy. Feel free to add your academic chops to any discussion.

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  3. Lara Lewis Says:

    Wow! You hit at the heart for me on this! My first son was induced at 40+3 and has had no issues at all and was a chunky, healthy baby who did everything on time or before. My second son was induced at 38 weeks. Had to go to special care for about 10 days after delivery for de-stating (originally went up for fluid in lungs) and has had big issues with weight gain and eating his whole life. He is nine months old and seems like a six month old. Size and abilities to move about, or not move about. Not getting up on hands and knees yet or pulling self up. I was a bit hesitant to induce at 38 but since the OB said I needed to since the ultrasound showed him being 7 pounds about a month or so prior to induction. I had lots of trouble getting my first baby out weighing 8 lbs 7oz. Doc thought I should go ahead and induce two weeks early to reduce chance of baby being as big or bigger than the first. Well, he came out weighing only 7lbs 6oz. Oh, he also has a milk allergy and eczema so I am nervous he will not outgrow it and we will have life long allergy issues. So I get a little mad every time I think that I should have listened to my intuition and not induce that early. But then you hear about all the others that have had no issues and think all will be fine. And I actually don’t know if his being two weeks early is the reason for allergies and weight gain and delayed progress. I am hoping beyond hope he will even out by around the time he is a year and half with his size and delays. He is nine months now and I am trying to teach him to get on his knees and hands to get back to sitting position.

    Sorry it is so long and drawn out, but I was in a mood to vent to someone who understands.

    Thank you for your postings!

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  4. Kate Says:

    Love this post. I agree with it completely and I am pleasantly surprised that it comes from a Doctor. Thank you for believing in nature knows best.

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