Let labor begin on its own.

For me there was never any talk of induction. In my first pregnancy I had transferred to a midwife's care about halfway through and she never said one word about it. Pre-internet and almost entirely dependent on my care provider for information, with my only other source of information being What To Expect When You're Expecting (aka "Don't Worry Your Pretty Little Head About Anything, the Doctor Will Take Care Of It") it didn't come to my attention and therefore I didn't think about it.

With that pregnancy I went to 41 weeks, and I know very well now that had I been in the care of a physician following his employer's protocol (I say "he" because, strangely, most primary birth dictators attendants in our culture are men) I would have been pressured to induce. 41 weeks is considered "late", though in her book The Thinking Woman's Guide to a Better Birth, which is stuffed full of studies and statistical information, Henci Goer points out that in fact the average beginning of spontaneous labor in first-time mothers is 41 weeks. (Technically 39 weeks gestation, but those wacky OBs like to count from last menstrual period, two weeks before the baby is actually conceived, which has become convention.)

Induction of labor carries the risk of a slew of complications. Depending on the method, it may require that the mother be prone which in itself creates a climate for complications to arise: movement and being vertical are important for proper positioning of the baby, signaling to the brain to send chemicals that contract the fundus down and soften the cervix, and pain management. If the baby can't move down easily and have the space to maneuver into an ideal position, it compromises the baby's safety and invites interventions like the use of forceps, vacuum extractor, and surgical opening of the vagina or abdomen.

It also makes the labor longer and harder, which makes the use of pain medication more likely, which brings its own risks: the mother unable to push normally resulting in damage to her body, drugs in the baby's system and affecting its ability to breathe, separation of baby and mother at birth - affecting bonding - with possibly painful tests done in the NICU.

Again, depending on the method, it can interfere with the mother's ability to produce her own hormones which can have serious ramifications not only for the progress of labor but for third stage (hemorrhage) and bonding. If the body is not ready to give birth induction can result in "failure to progress" and from there cesarean section. There is also an increased risk with induction that the baby will be born prematurely (with attendant medical issues,) and increased risk of placental abruption, where the placenta separates from the uterus before the birth is complete.

That's the short list of what I avoided, not because I'd done any research of my own, but by lucky accident of having innocently chosen a care provider that didn't practice that way. She did however have her own ideas about what sort of situation would justify intervention. In my case it was not that my pregnancy was taking "too long" but that (according to her) my labor was. I was doing well, in good spirits and energy despite not having slept much, but she was impatient to get things moving along faster. So she suggested that I augment the labor with a natural substance that stimulates the uterus: castor oil.

Now, this woman was licensed to practice by the state, she had attended by her estimate over 1500 births, she was trained as a nurse, and she was well regarded in the community. I assumed (replacing the "doctor as god" mentality with "midwife as god" mentality) that she knew what she was doing. Why on earth else would I hire a professional? Consider too that all those studies show the safety and superior care of midwifery; of course she must know what she was talking about.

Further, this method of induction or augmentation is supported in the natural birth literature, and there are doctors who prescribe it as well. Surely it would be safer than injecting the body with artificial hormones? I had not educated myself at all about birth (reading the aforementioned piece of crap book and taking a completely useless childbirth class at the hospital don't count,) so I felt completely dependent on her to tell me what to do -- the situation that most patients find themselves in, and which most care providers encourage. And I was indeed a "patient" at that point.

So she mixed up a concoction for me consisting of the castor oil, some kind of alcohol, and orange juice, according to the Susun Weed recipe in the book Wise Woman Herbal for the Childbearing Year. (Susun Weed, too, is well-known and highly respected.)

I had a vague idea that the castor oil would increase the frequency of contractions. It also made me feel like I was going to die. (I later found that there are risks to the baby as well.) I have never experienced such severe intestinal cramping in my life and can't imagine it possibly being worse. I spent the next hour on the toilet spurting diarrhea, weeping and moaning in agony, trying desperately to escape my body, with people gathered around me "supporting" me with words like "you're doing great," etc. (Why is it that in labor things that normally demand privacy suddenly are regarded as public events?)

The midwife chose this time to explain to me that I had been emotionally resisting the labor (!) and that this illness was going to force me to "let go". I was and am offended by this armchair psychoanalysis. Who was she to say why my labor was progressing the way it was and that there was something wrong with it? I was doing just fine until she got involved. Now angry and resentful and having lost trust in her, the labor became difficult and stressful, neither of which made it a safer situation for the baby.

Not that I'd have been better off with hospital management: pitocin (a synthetic form of oxytocin, the hormone that stimulates uterine contractions, among other things) would have been used instead, and it  would have been started long before 48 hours of labor. It's commonly used and can be, as many women have attested to, a horrific experience, making the labor unbearable, so that pain medication becomes necessary. It increases risk of placental abruption and fetal distress and more.

It's good that people are questioning induction, but it's really only part of a larger issue, that of whether labor should be allowed to follow its own timetable from beginning to end, assuming that the mother and baby are both fine. (It should.)

My next three births weren't interfered with. None of them went as long gestation-wise, but one was another long labor. Unlike the first, it was allowed to progress as my body needed it to. With my first labor, the intervention caused hours of agony, emotional trauma, physical injury, and a sense of disconnection from my baby. With the long labor that was allowed to progress undisturbed by outside intervention, there was a relatively easy and lovely emergence with no harm done to the baby or me or us as a mother-baby unit.