The Disadvantages of Medical Ways to Induce Labor
Amniotomy | Pitocin | Cervical Ripening Agents
There are many medical ways to induce labor. I will address only the most common of these different ways to induce labor. I feel it's important to note that true reasons for induction such as serious maternal or fetal medical conditions or real post-date complications occur only in approximately 3% of pregnancies. The current induction rates are estimated at 1 in 5, or 20%.
In the Listening Mothers nationwide survey (2002), 44% of women reported that their caregiver tried to induce labor. 18% cited a non-medical reason as the only reason to induce labor. 16% reported that a combination of medical and non-medical reasons led to the choice to induce.
A different study, titled "First Births - A continuous Quality Improvement Project" revealed that a 22% reduction in labor inductions in first-time mothers resulted in a 21% decrease in cesarean births. No significant changes in newborn health or outcomes were noted.
YIKES!
The disadvantages of medical ways to induce labor are numerous. All methods are invasive and when performed before a woman's body is ready for labor, can lead to an unwanted and unnecessary "cascade of interventions".
This "cascade of interventions" refers to the fact that not one of the medical ways to induce labor can be performed in isolation. Each requires the mother to lie in bed. This counteracts the effects of gravity and prohibits her from walking, both of which can slow labor. Most require an IV as well.
All of the medical ways to induce labor can lead to stronger, more painful, and more frequent contractions, which may lead the mother to use pain medications otherwise not required. These powerful contractions may also limit oxygen supply to the baby, so increase the risk of fetal distress.
Also, due to the uncertainty of due dates, and the variation in the amount of time any given baby requires to reach maturity, early induction carries a risk of causing a premature birth.
I'll address the co-occurring interventions for each of the medical ways to induce labor separately.
Most
medical ways to
induce labor either aim to ripen the cervix with prostaglandins
(natural or artificial) or to start uterine contractions.
In the spirit of perversity, let's talk about the latter first.
AMNIOTOMY
This is commonly referred to as "breaking your water" but is also known as "artificial rupture of membranes" (AROM) or "premature rupture of membranes" (PROM). It is also considered the most "natural" of all the medical ways to induce labor. You will soon see that is not the case. A crochet hook is inserted to tear open the bag and release the amniotic fluid. This method is usually chosen if the cervix is already around four centimeters dilated and is already effaced.
It
is commonly used to "speed up" labor. However, when used
inappropriately or before a woman is truly ready for labor, it can lead
right to a cesarean section. This occurs for several reasons:
Once
your bag of waters is ruptured, the clock starts ticking. Most doctors
want your baby birthed as soon as 6 hours post-onset. Some will go as
long as 24, but that's a stretch.
Another
disadvantage is that once this procedure is performed, you are most
likely required to
remain prone in bed. Continuous
electronic fetal monitoring is also likely, which will further restrict
your movement. Throw in an IV and you'll be lucky to turn over. This is
due to the risk of a prolapsed cord, where the umbilical cord falls
below the baby's head into the birth canal and is at risk of being
compressed during contractions, which in turn can lead to fetal
distress and a decreased heart rate. It eliminates gravity and walking,
both of which are proven to aid in speeding labor. In effect, the
procedure can actually slow
labor.
So
what's at the end of this "cascade of interventions"? You guessed it. A
cesarean section. And all because your doctor wanted to "speed things
up".
Amniotomy
can also result in a
little-considered side effect. The bag of waters not only protects the
baby, but it also acts as a cushion between the baby's head and your
cervix. To put things in perspective, let's imagine that the bag of
waters is a pillow, and the baby's head is a brick. Visualize the brick
(baby's head) repeatedly slamming down into the cervix. Now visualize a
pillow between the brick (baby's head) and the cervix.
Which scenario would you prefer?
When breaking your water does not lead to steady contractions or your are up against the clock, then the next way of inducing labor may be attempted.
PITOCIN INDUCTION
In a pitocin induction, you will be required to lie in bed with an IV and continuous fetal monitoring. Again, kiss gravity goodbye. Pitocin is the synthetic form of oxytocin, the natural labor-causing substance that is usually produced by the mother's own body. Pitocin is given in very small doses through an IV (intravenous line or catheter). Every half hour or so, the nurse or doctor checks the uterus's response to the current dose of Pitocin, and makes an adjustment.
Sounds
simple enough, doesn't it?
Well, don't believe everything you hear. Of all the medical ways to
induce labor, this is my least favorite. While doctors have been able
to replicate oxytocin, they haven't been able to replicate the method
of delivery. This is due to the fact that when a woman's body releases
oxytocin during a contraction, it is released as a single burst, not a
continuous drip. After each contraction, the uterus is able to rest.
When the next contraction begins, anther burst of oxytocin is released.
This start-stop-start-stop method prevents the uterus from becoming
over-stimulated.
When
using pitocin as one of the ways to induce labor, the
pitocin is administered via an IV drip. Although it may be set at a low
rate, it is still a consistent drip. If labor is not progressing fast
enough for the doctor's liking, the drip is often increased. This leads
to fast, constant contractions that can commonly cause the uterus to
become hyperstimulated and lead to the cascade of interventions
previously detailed.
Another common type of induction is the use of various cervical ripening agents. However, these agents are actually the first step. They are seldom used alone and are typically followed by one of the previously mentioned interventions.
CERVICAL RIPENING AGENTS
In this type of induction, either a gel (Prepidil) is placed within or around the cervix with a syringe, or a tampon-like insert (Cervidil) is placed inside the vagina with a time-release medication. The latter can be removed if hyperstimulation occurs.
Some
doctors will recommend Cytotec (Misoprostol) for induction. This comes
in tablet form that is either placed behind the cervix or given orally.
It is cheap and more likely to start labor than either Cervidil or
Prepidil. However, and this is a big however, Cytotec is NOT
approved by the FDA for labor induction. Few scientific trials have
been
done to establish effective dosage, effectiveness, and safety for
mother and baby. An increased risk of uterine rupture, especially in
VBAC moms has been documented.
If
your
practitioner recommends or uses this drug as one of his medical ways to
induce labor, I would seriously consider searching for a new one. It
can be a hassle, but it's definitely worth it. With my second child, I
switched care providers at 28 weeks and it was the best decision I
could have made.
If
you
still need convincing
about the disadvantages of medical ways to induce labor, ask your
doctor to see the hospital consent form for induction. You might be
surprised to find that it reads something like this: "risks may include
a longer labor, increased hospital stay and recovery time, a higher
chance of forceps and/or vacuum extraction, more bleeding or infection,
and increased cesarean rates."
So what do you do if your caregiver wants to induce?
Advocate for yourself.
Remember, you hired that person. They are working for you.
Make them earn it. Ask about the natural ways of inducing labor
detailed on the previous page. You must ensure that the benefits far
outweigh the risks.
References
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Giving Birth Naturally: Natural Ways to Induce Labor: Medical Ways to Induce Labor
