Induction of Labor

One of the choices faced by as many as a third of US women in late There are legitimate medical reasons for induction. These include cancer, hypertension, small for dates baby, a decrease in the amount of amniotic fluid or an intrauterine death followed by a long wait for labor to begin (we’re talking weeks, not days) In these cases, the risks posed )J the induction method are more likely to be outweighed by those associated with waiting for the natural kick in studies agree that fewer than ten percent of women A consensus meeting .anized by the world health Organization on Appropriate Technology for ^th held in portaleza, Bra*ilN jn 1985 recommended “No geographical region should have rates of induced labor over ten percent).

Obviously, nonmedical reasons to induce labor have increased over as working women and obstetricians try to crowd more into already busy schedules and as new drugs have become available.

The US Induction rate doubled between 1989 and 1998 (from 9 percent to 192 percent) and is apparently still rising, although there was no corresponding rise in the size of babies, the length of pregnancies, or the incidence of maternal llnesses requiring inductions many inductions taking place, a common misconception has arisen with no disadvantages from the procedures used. Most (US Working women, with only six weeks of maternity leave to look forward to, are understandably

ready to start labor if there are no risks associated with induction. They assume-often wrongly that their caregiver will inform them of any risks induction might carry.

Disadvantages to the Mother from Induction

Labor (including its onset) involves an extremely complex interplay of hormones that cannot be altered without upsetting the normal physiological pattern. Changing the normal pattern often causes other problems, necessitating more obstetrical interventions. An induced labor is quite a different process from spontaneous labor, fcfomen tend to have harsher, stronger, significantly more painful contractions with chemically induced labors, so one who can cope with a spontaneous labor of ten finds that she needs pain medication to bear the moreens istent of an induced one. When labor is induced with J>itocin (see p> 210)5 an intravenous infusion has to be set up. The laboring woman s mobility is automatically restricted in these cases because of the discom fort caused by the t V- needle in her vein and the tubes that attach her to the | V. stand. Even though J.V. Stands have wheels, they are far from Rarely, but far less rarely than in spontc pharmaceutical induction can rupture the uterus. Event cal) * for emergency cesarean section and, sometimes, hysterec tomf* Increased postpartum blood loss is another problem associated with artificial i^liction of labor.

Pisadvantages to the Baby from Induction

main justification for artificially inducing labor is a reduction the number of compromised babies. The problem with at least half the artificial inductions taking place in the Jnited States at present is that the induction method itself can compromise the baby* OxTtonn and prostaglandin inductions are well known to cause longer, more thus interfering with the flow of ‘iWflwietil jn9oi ot theirijus fetal monitoring is usually part of the protocol of the m^or the fetal-monitoring machine to record the feta.)heartbeat, the mother must lie still in bed. If she wants a little more mobility, she can opt to have an internal scalp electrode needle inserted into the baby’s head, but this is painful to the baby, requires breaking water bag, and can cause infection to both mother and baby, Another heightened risk to the baby from labor induction is related to the higher incidence of fetal distress in induced labors compared with labors that begin spontaneously: A cesarean is more likely to take place t induced labor than in one that begins naturally. In one study, rate for abnormal fetal heart patterns doubled.5 The uterine contractions of labor squeeze out the fluid that is naturally in the baby s lungs during pregnancy; with a cesarean, this process is circumvented, and the baby’s lungs are more likely to be wet at birth, causing breathing difficulties.

Oxytocin and prostaglandin inductions are both known to increase the passage of meconium during labor, probably because the baby js more stressed than it would be during a labor that began on its own. Se^ era} tudies of labors have documented high rates of meconium in those induced by the rwest prostaglandin, Cytotec (discussed in more detail on p. 21 !).*•# ^hen there is thick meconium in the amniotic fluid during labor, the baby sometimes inhales it with its first breath and has serious breathing problems. Newborn jaundice is another problem encountered more frequently after induction than in natural labors, whether the baby has meconim aspiration or jaundice, it is likely to spend its first few days in the speciaJ-care nursery instead of in its mother’s arms. Jiave you ever heard of iatrogenic prematurity) ‘fhe term means doctor-caused prematurity and had to be invented because so many pre; bora after labors were induced or cesarean operations “due dates, rhe myth is that obsterric science is so highly evolved that it is no longer possible to be mistaken ibout when a baby is due. The reality is that iatrogenic prematurity is far mfre common than most obstetricians like to admit. Too often, it hapis after a “convenience” lnduction-the kind performed for nonmedical reasons.

Common Induction Methods

most common medical methods used to induce labor are breaking waters (ammotomy) and various chemical methods: pitocin intravenous drip and the administration of various prostaglandins vidiL Prepidil,and Cytotec).

Breaking the waters

Breaking the waters is a crude but r sometimes effective way to start labor when a woman is about to go into labor on her own. This method will initiate labor within twenty-four hours in seventy to eighty percent of women. The problem is that the remaining twenty to thirty percent of women who will experience a high incidence of intrauterine infection, breaking thewaters alone does not increase the danger of uterine rupture. However, this method puts a time limit on labor to start and conclude in most pitals because of the heightened risk of infection. Sometimes am niotomy causes the umbilical cord to fall out of the cervix below babys head, causing a life-threatening emergency for the baby.

Pitocin Intravenous Drip.

-pitocin is a synthetic version of oxytocin, a natural hormone that is released from the mother’s pituitary gland in tiny amounts during (not be $cre) labor. Given intravenously, a dose that is far larger than that which is naturally secreted in early labor is increased every few minutes until the desired contraction rate is reached, pitocin induction is more apt than a spontaneous labor to result in a vacuum-extractor or forceps de livery or a cesarean section because of fetal distress stemming from too strong uterine contractions, oxytocin doubles the odds of the baby >t cause interfere with the flow of oxygen-rich blood from mother to baby. Another hazard of oxytocin induction is an increased incidence of postpartum hemorrhage.

Oxytocin, by the way, is also used to strengthen contractions in a slow-moving labor.

Oxytocin induction is often unsuccessful, even when it is combined with amniotomy. This is especially true when the cervix is not yet rijtr (soft and thin). Some women undergo attempted pitocin induction for three or four days without evergoing into effective labor.

Obstetricians a generation ago were taught never to leave a mother alone during an oxytocin induction.1* ^hen there is an overdose (some women are more sensitive to the drug than others) resulting in abnor mally strong and lengthy contractions, the intravenous drip can be turned off. Pitocin has a half-life in the body of ten to fifteen minutesThere is a much higher incidence of uterine rupture in chemically induced labors than in spontaneous labors. Generally, the unscarred uterus does not contract so hard as to destroy itself in naturally occurring labors. With induction, between one and three percent of women have a ruptured uterus. Add the factor of previous cesarean to induction, and the rate rises. Nearly six percent of the women in one study had ruptured uteri after a chemically induced labor.