5 Ways to Prevent the Need for Induction of Labor – A Response to the ARRIVE Study

— by Faith Groesbeck, BA, CCCE, CD (BAI)

This month, the results of the ARRIVE study, or A Randomized Trial of Induction Versus Expectant Management, were presented at the Society for Maternal-Fetal Medicines annual meeting, called the Pregnancy Meeting™. This study is explained in more depth on the Evidence Based Birth® website, in the article on due dates.

The research showed that in over 6,000 women, inducing labor at 39 weeks without any other medical indication, reduced the overall risk of cesarean, developing pregnancy complications and harm to the baby. While advocates warn that this may mean that we face a future in which all pregnancies will be forced to end before reaching their due date, I’m a little more optimistic. In my experience, I’ve found it more likely that the pregnant person will choose an induction once this becomes an option for them rather than their healthcare provider imposing it on them. Provider practices vary greatly across the country, so I’m not sure this is the case everywhere, but to date, no professional organizations have said that this should become the standard of care (SMFM).

This research brings attention to two sides of the coin when it comes to the induction debate between those who advocate for physiologic birth versus those who seek better outcomes through technology. On the one hand, birth is a normal process, best left unhindered when possible. On the other, the longer a person remains pregnant, the more likely they are to develop pregnancy complications and the more time the fetus has to grow inside the uterus. I’m not saying our bodies are not marvelous and capable of birthing babies much larger than average, which is around seven and a half pounds.  I’m sitting somewhere in the middle of do nothing and intervening thinking, is there a way to prevent the need for induction and still have good outcomes?

While I realize the tremendous pressure parents are under to do everything “right,” I’ve also spoken to a lot of women who have said that if they had known that there was any chance that they could have possibly prevented the need for an induction or a cesarean, they would have gladly made changes in their lifestyle to at least reduce the risk.

So, here are some tips that may help to reduce the need for induction. I’m not saying that if everyone follows these ideas that they are guaranteed the outcome they desire or that women who do not do these things are at fault if intervention is necessary. I am saying that we may have some control over outcomes if it is our desire and within our means to explore these options. As always, please consult with your healthcare provider before making dietary or fitness changes during pregnancy.

  1. Hire a doula. Having a doula present at your birth increases the likelihood of having a spontaneous vaginal delivery (Hodnet). A spontaneous vaginal delivery is when the pregnant person goes into labor on their own, without the use of drugs and that the baby is born without the use of forceps, vacuum extraction or cesarean.
  2. Eat Dates. Several studies have shown that eating dates at the end of pregnancy, can reduce the need for an induction (Al-Kuran; Jadidi and Kordi). The general recommendation is to eat 6 dates per day, starting at 36 weeks.
  3. Practice Yoga. While yoga has many health benefits throughout a person’s life, a study done in Iran found specifically that doing one hour of yoga, six times per week, starting at 26 weeks, reduced the need for induction and resulted in fewer cesarean births (Jahdi).
  4. Quit Smoking. Smoking is a risk factor for having a smaller than expected fetus or having the amniotic sack, or bag of waters, break before their due date. Both may, under certain circumstances, be indications for induction of labor.
  5. Eat a Low GI Diet. While early induction for those who develop diabetes in pregnancy is not evidence based, gestational diabetes does increase the risk of developing other complications which may then make induction the safest choice. Eating a low glycemic diet during pregnancy decreases the risk of developing gestational diabetes and thus the risk of developing further complications (Brand-Miller).

As a doula, I’m here to support families, often with otherwise healthy pregnancies, who face decisions around inductions. I’m also glad that through childbirth education, families can adopt healthy lifestyle practices that may be able to prevent the need for an induction in the first place.

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Al-Kuran, O., Al-Mehaisen, L., Bawadi, H., Beitawi, S., & Amarin, Z. (2011). The effect of late pregnancy consumption of date fruit on labour and delivery. Journal of obstetrics and gynaecology31(1), 29-31.

Brand-Miller, J., Marsh, K., & Moses, R. (2013). The Low GI Eating Plan for an Optimal Pregnancy: The Authoritative Science-Based Nutrition Guide for Mother and Baby. Workman Publishing.

Hodnett, E. D., Gates, S., Hofmeyr, G. J., Sakala, C., & Weston, J. (2012). Continuous support for women during childbirth. Cochrane Database Syst Rev10.

Jadidi, M. Y., Sang, S. J. B., & Lari, H. (2016). The effect of date fruit consumption on spontaneous labor. Journal of Research on Religion & Health1(3).

Jahdi, F., Sheikhan, F., Haghani, H., Sharifi, B., Ghaseminejad, A., Khodarahmian, M., & Rouhana, N. (2017). Yoga during pregnancy: The effects on labor pain and delivery outcomes (A randomized controlled trial). Complementary therapies in clinical practice27, 1-4.

Kordi, M., Aghaei Meybodi, F., Tara, F., Nemati, M., & Taghi Shakeri, M. (2014). The effect of late pregnancy consumption of date fruit on cervical ripening in nulliparous women. Journal of Midwifery and Reproductive Health2(3), 150-156.

Society for Maternal-Fetal Medicine. (2018, February 1). Induced labor after 39 weeks in healthy women may reduce the need for cesarean birth: More information is needed before changes to clinical practice are made. ScienceDaily. Retrieved February 16, 2018 from www.sciencedaily.com/releases/2018/02/180201115718.htm

6 is the New 4: Changes in the ACOG Guidelines

From “The Birth Series,” circa 1975

In March of 2014, the American College of Obstetricians and Gynecologists (ACOG) released a statement called “Safe Prevention of the Primary Cesarean Delivery.” In that statement, they outline some ways to decrease cesareans, including:

  • Letting early (latent) labor progress without time limits.
  • Changing the definition of active labor from 4 cm to 6 cm.
  • Not diagnosing “failure to progress” (no adequate contraction or cervical change) during active labor before four hours without oxytocin and six hours with.
  • Letting those who have delivered vaginally before to push for at least two hours, three hours if they haven’t, and even longer in some situations, like an epidural or posterior baby, before a cesarean is recommended.
  • Using instrumental delivery, for example vacuum extraction or forceps, to help with vaginal delivery and avoid cesarean. This includes ensuring new doctors are learning these skills.
  • Counseling patients to avoid gaining over the recommended amount of weight during pregnancy.

I became a doula the year these changes were implemented, although I had attended several births before my career change. It wasn’t until I participated in an online webinar through GOLD Learning’s Online Symposium on Childbirth Education with Penny Simkin, entitled, “The Tipping Point(s) in Childbirth Education & the Consequences of Ignorance,” that I really understood how these changes were affecting my practice as a birth worker and impacting the experiences of the clients I served.

According to Simkin, time and patience are allies of the parent and baby, but our job as childbirth educators, doulas and advocates, is to convince birthing women that these things are important! Since “Longer labors are harder on women,” Simkin says, “motivation, incentive and know-how are essential” and that “when people understand why and how to avoid a c-section and are assisted along the way, the odds of success improve.”

When I consider my recent experience as a childbirth educator and doula, her wisdom really resonates with me. Birthing people are often sent home, multiple times, after being told they are not yet in “active labor,” which can be discouraging when their bodies are giving a different message. Preparing them for this possibility begins with educating them about the high rates of cesareans and how ACOG guidelines defining 6 as the new 4 for active labor is a positive change to help them achieve the birth they desire. Next, providing strategies for staying home as long as possible can put them in a better mindset for the long-haul ahead of them.

Along with realistic birth preparation, childbirth educators and doulas can provide strategies that can be used during labor to help increase endurance: nourishment, movement, relaxation and rest. Encouragement is also key, so believe in the birthing person and their body’s ability to birth from beginning to end and let them know you do!