birthing with guinever

think twice, no think three times before being induced for labor April 11, 2009

My pregnant readers often ask if I think they should be induced.  After reading each scenario, my usual thought is, “No.”  But that is a decision to be made by a woman after discussing it with her medical care provider.

Read “Don’t let this happen to you”  part 1 and part 2 written by a labor nurse all about a birth that started with an unnecessary induction.

Questions to consider before saying yes to induction:

1. Will my health be compromised if I continue my pregnancy?
2. Will the baby’s health be compromised if I just wait for labor to start on its own?
3. What will happen if I don’t induce today, tomorrow or next week?
4. Why does the doctor want to induce? Is it for his/her convenience or is it for the health of me and my baby?

Consider this:  50% of inductions in first-time mothers result in a cesarean birth. Yikes!  That’s half. The over-all cesarean rate in the U.S. is currently 31% according to the CDC (Center for Disease Control and Prevention.)

The cesarean delivery rate rose 2 percent in 2007, to 31.8 percent, marking the 11th consecutive year of increase and another record high for the United States.

Not all inductions are bad or unwarranted. If you have a medical condition such as very high blood pressure, diabetes (not gestational diabetes), pre-eclampsia, an induction is desirable. An induction should be considered only when mother or baby is in danger if the pregnancy continues.

Common non-medical reasons for induction

1. Doctor is going on vacation
2. Doctor wants to do all his deliveries during the day and not get called in the middle of the night. He wants to control the timing of your labor.
3. Doctor gets paid more for a surgical birth than for a vaginal birth.
4. It’s the last week of December and the couple wants to be able to claim the new baby as a deduction on their taxes.
5. Couple’s parents are in town for the birth and so they “need” to induce before they go back home.
6. Mom wants to plan her birth so she can time her maternity leave for work.

So why do many inductions end in surgery?

It’s because the body just isn’t ready for birth. The cervix isn’t ready to dilate. If you’re nearing your due date and you or  your doctor wants to induce, please consider the bishop score which takes into account baby’s position, and the dilation and effacement of the cervix. You can take this short 5 question quiz based on the Bishop score to see if being induced might work for you.

Here’s an all too common labor scenario:  Mom can’t handle the high doses of pitocin so her blood pressure goes up. This affects the baby. Mom gets the epidural because she can’t handle the contractions on pitocin. The epidural makes the labor slow down, so the pitocin is increased. Afterall,  she can’t feel the contractions anymore. Baby increasingly gets worse and worse until a cesarean is needed to save the baby. Mom is worn out and can’t take care of her baby who is having trouble breastfeeding because he’s so lethargic from the drugs that crossed over the placenta.

induction 101

If your cervix is really soft, you might get to skip this first step and just go to the hospital in the morning. But if your cervix is hard like the tip of your nose, you’ll be asked to come in at night and you’ll be given a prostaglandin on your cervix for the purpose of softening it. Some women are able to sleep through the night. Other women feel contractions and are uncomfortable enough that a good night’s sleep is impossible. By morning, your cervix should be nice and soft and ready for the next step in the induction. How long does it take the cervix to dilate 5 centimeters?  But first, let’s answer the following question:

what’s a prostaglandin?

Naturally occurring prostaglandins are in semen. Therefore, you can have all the prostaglandins you could ever need and want in the comfort of your own home. The best way to soften your cervix is to have sex with your husband several times during the last month of your pregnancy.

There are two chemical prostaglandins approved by the FDA for the purpose of inducing labor. They’re the pge2 type and they’re cervidil which is similar to a tampon that is inserted and then can be pulled out and prepadil which is a gel that is rubbed onto the cervix.

But there’s another prostaglandin that’s a lot cheaper than the two mentioned above.  It is not approved by the FDA for labor.  It’s called cytotec and it is used in the treatment and prevention of stomach ulcers. But because it is a prostaglandin and it’s cheap, doctors started experimenting with it to see if it would work during labor.  To quote a labor nurse,

Cytotec turns the cervix to mush. It works really well.

Another name for cytotec is misoprostol. Here’s the FDA fact sheet on misoprostol. Cytotec should not be used during labor; it can over-stimulate the uterus at the least and cause death of mother and child at the worst.

so what happens if you say no to induction?

Wait. Be patient. It’s hard sometimes; I know. Be aware of baby’s movements. Continue your pre-natal visits to monitor the baby’s health and your health. If everything is ok, be confident in your body’s ability to birth your baby. Your body has grown and nourished your baby for nine months and still can. Labor will start. No one was pregnant forever.