I missed everyone in September so much!!! Not to mention that it's never fun to have to skip doing something because you're sick. I've been hearing so much lately about people having elective inductions and them going poorly that I really felt strongly that it was something we should discuss. I, myself had two inductions and an augmentation of labour and did not know half the risks involved. Of the women attending our meeting that had children, all of us had experienced at least one induction. I think this is absolutely an epidemic, and mothers are not being informed of the risks to them or their babies.
I tried really hard to find good numbers concerning how many women are induced, and wasn't able to find anything solid. The following are the different results I came up with.
1 in 5
One study listed a rate of 43.6%
Varies widely from hospital to hospital 12%-55%
A survey done in 1998 showed that 81% of women had been given Pitocin.
As you can see, finding actual information can be difficult. Based on talking to women in our area, I think the numbers are pretty high, probably falling somewhere between the 55% and 81%.
The most common method of induction is a combination of having your bag of waters ruptured and IV pitocin,.
Some women will also be given a cervical ripening agent.
Cervidil/prepidil - Dinoprostone is a gel that is placed directly onto the cervix through the vagina using a special applicator. Your doctor, nurse, or other healthcare professional will give you this medication. Sometimes, it is inserted with a string, so it can be removed if mother has a reaction.
Yet another method of induction is a drug called Cytotec or Misoprostol. I will discuss side effects and risks of induction a bit later, but I just want to say here that if your doctor or midwife does Cytotec inductions that you may want to seriously think about looking for a new provider.
When you have an induction:
You will be attached to an IV
You will have continuous fetal and maternal monitoring, which inhibits your movement.
You may or may not be allowed off the monitor even long enough to go to the restroom, having to use a bedpan.
What reasons are given for inductions?
According to Mayo Clinic:
You're approaching two weeks beyond your due date, and labor hasn't started naturally.
Your water has broken, but you're not having contractions. (within 24 hours)
There's an infection in your uterus.
Your baby has stopped growing at the expected pace.
There's not enough amniotic fluid surrounding the baby. (oligohydramnios) - Be sure to drink plenty of water before a sonogram. Some doctors will use "low fluid" as an excuse, when, in fact, your fluid will replinish itself. Drinking extra water should ensure that you have adequate fluid levels unless there is actually a problem.
Your placenta has begun to deteriorate.
The placenta peels away from the inner wall of the uterus before delivery — either partially or completely. (placental abruption)
You have a medical condition that might put you or your baby at risk, such as high blood pressure or diabetes.
Reasons offered for induction, but not advised include:
Social – namely, convenience or just wanting to know the date your baby is coming
Maternal age – namely, inducing you because you are ‘older’
Because it is your caregivers ‘standard management’
For hospital convenience (unless lack of anaesthetic cover is a consideration)
Mother being “over it” or sick of waiting
Doctor / Midwife going on holiday / golf / conference / disruption to consulting sessions
Partner going on holiday
Family staying from out-of-town and needing to return home
Wanting your baby born on a specific date
Wanting a smaller baby (unless medical indication)
‘9 to 5 obstetrics’ – some hospitals, mainly private ones, have a 90% induction rate termed 9 a.m. to 5 p.m. obstetrics, so the care-giver is not woken overnight to attend births.
What are the risks of inductions?
According to Mayo Clinic:
The need for a C-section. Labor induction is more likely to result in the need for a C-section — particularly if you've never given birth before and your cervix hasn't already begun to thin, soften and dilate (unfavorable cervix). (Doubles your chances)
Premature birth. Inducing labor too early might result in a premature birth, which poses risks for the baby, such as difficulty breathing.
Low heart rate. The medication used to induce labour - oxytocin or a prostaglandin - might provoke too many contractions, which can diminish your baby's oxygen supply and lower your baby's heart rate.
Umbilical cord problems. Inducing labor increases the risk of the umbilical cord slipping into the vagina before delivery (umbilical cord prolapse), which might compress the cord and decrease the baby's oxygen supply.
Uterine rupture. Uterine rupture is a rare but serious complication in which the uterus tears open along the scar line from a prior C-section or major uterine surgery. An emergency C-section is needed to prevent life-threatening complications.
Bleeding after delivery. Labour induction increases the risk that your uterine muscles won't properly contract after you give birth (uterine atony) which can lead to serious bleeding after delivery.
Additional risks include:
Increases the chances of needing forceps, or vacuum delivery.
Doubles the mother’s chance of urinary incontinence in the future.
Stronger, more frequent contractions put additional stress on baby.
Pitocin (synthetic oxytocin) inhibits the body’s production of natural oxytocin.
The long-term effects of labour induction to the child are not fully known or researched.
Cytotec:
Cytotec is NOT approved by the FDA for labour induction!
Unlike Pitocin or Cervadil, once Cytotec is given, either in a pill form by mouth, or inserted vaginally, so there is no way to stop its action, even if trouble occurs.
Cytotec was invented to treat gastric ulcers, and that is the only use that the manufacturer recommends for it.
Searle, Cytotec's manufacturer, sent physicians a letter reminding them that Cytotec was not approved for use as a cervical ripening agent and that it was contraindicated for use in pregnancy. The letter listed serious adverse effects associated with using Cytotec, including maternal or fetal death, uterine rupture, and severe vaginal bleeding and shock.
Research your health provider carefully! As I was looking for information on Cytotec, I discovered that certain local midwives actually use Cytotec.
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| Notice the image of a pregnant woman with a big red cross through it! |
Some natural methods of induction can be effective. While induction is not optimal, if you're in a situation where one is needed, trying some natural methods first may be a good option for you. None of these, however, are full proof. If the baby isn't ready, they won't work.
Natural methods of induction include:
Nipple Stimulation – causes oxytocin release
Sexual Intercourse
Castor Oil
Enema
Herbal induction methods all of which should be researched thouroughly.
Bottom line? If you don't have to, don't.
I thought the following statement was particularly interesting given the number of inductions done in the American health care system. Again, from the Mayo Clinic.
“Inducing labor is a serious decision. Work with your health care provider to make the best choice for you and your baby.”
Mark your calendars for our next meeting on November 17th and join us! :)
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| Clara liked the Hummus! :) |
