— 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.
- 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.
- 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.
- 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).
- 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.
- 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 gynaecology, 31(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 Rev, 10.
Jadidi, M. Y., Sang, S. J. B., & Lari, H. (2016). The effect of date fruit consumption on spontaneous labor. Journal of Research on Religion & Health, 1(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 practice, 27, 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 Health, 2(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