Are some forms of induction harmless?
In our Birth Partners Workshop, we ended up in a brief conversation about how maybe there is no harm in some forms of induction. Inspired by the conversation, I wanted to write you a blog post about a brief overview of Induction and augmentation of Labor and present some of the disadvantages that should be taken into account when making an informed decision (and you can always ask about the side effects!).
When is it used and why?
There are two common scenarios when the induction is used. Sometimes, labor is started artificially, and other times, when the labor has slowed down significantly, it’s artificially speeded up.
It’s good to point out that any intervention to speed up labor, whether it’s a more holistic/natural approach, or medicalized, is a form of intervention. Some natural forms of induction are nipple stimulation, sexual intercourse, castor oil, acupuncture, and acupressure. Other ways performed by medical staff include Artificial Rupture of the Membranes, Stripping of the membranes / Sweep, Prostaglandin in gels, tablets, or suppositories, and the synthetic oxytocin (Pitocin) which is administered intravenously.
There are medical and legitimate reasons for using it, some of it for example:
Mother having diabetes, high blood pressure, positive for Strep B with waters broken for a long time, frequent herpes outbreaks, or any problem where continuing pregnancy presents a risk for baby’s health
When pregnancy has gone too long. According to the American College of Obstetricians and Gynecologists, without the present medical problem, induction before 42 weeks of pregnancy exceeds the risk of waiting. In 42 - 43 weeks of pregnancy, the risk of stillbirth exceeds the risk of induction.
Prolonged labor with cervix still firm and thick - Prostaglandin can be useful to soften it
There are also non-medical reasons, some of it being:
Routine procedures in a hospital where you decide to give birth - even though it leads to a greater possibility of babies being born prematurely (elective induction has been identified as a preventable contributor to the high 10% rate of prematurity in the USA), or the increased possibility for a C section.
Your discomfort, not wanting to be pregnant anymore
You want to be in your chosen caregiver’s shift
Disadvantages of elective induction
When you opt for the elective induction, it often comes with other medical procedures, such as continuous fetal monitoring, which most often restricts the mother’s movements (preventing you from using the freedom of movement and your natural instincts to place your body in a way that responds to your baby’s needs in order to position and rotate - which can continue into the cascade of interventions) and also produces very complex tracings, which different medical personnel will read completely differently, affecting the following interventions and when will they consider them needed.
If the mother’s cervix is thick and firm, induction can proceed very slowly (it can take days). This can be demoralizing and really tiring, physically and mentally. The babies continue to mature in those last days, and the babies actually come when they release the hormones that initiate labor.
For first-time mothers, there is a greater chance to end up in a C-section if the labor starts with an induction, rather than spontaneously.
The Artificial Rupture of the Membranes increases the risk of infections with time after the rupture and the number of vaginal exams. Very often, it doesn’t start, or speed up the labor. If the baby’s head is not well positioned on the cervix, breaking the waters and removing the fluid cushioning between them may take away space for a wiggle and decrease the chances for repositioning the head right. There is a higher chance of compressing the umbilical cord during the contraction, causing the possible oxygen shortage for the baby, and in some cases, the danger of prolapsed umbilical cord increases.
Prostaglandin is used to soften and ripen the cervix but sometimes causes rapid changes in blood pressure and nausea. High doses in the form of a tablet can cause very intense and sudden contractions and fetal distress, which is less likely with other forms of prostaglandin.
And finally, due to the continuous fetal monitoring and the IV fluids, a mother is often prevented or restricted from using natural, comfort measures that can help cope with pain and progressing in labor - such as movement, changing positions, massage, etc. The contractions experienced with Induction are often much stronger, or start being very intense a lot earlier in labor, that a woman feels like - if this is how it is now, how will it be later when they actually should become stronger?! - which often leads to further medicalized pain management rolling into a cascade of interventions.
Medical procedures are here to save lives and deal with complex pregnancies and complex labors - and are absolutely welcome! However, if you are experiencing a low risk pregnancy and don’t have other indicators that might put you into any risk group, it’s really worth it to inform yourself about both + & - or what you will most likely be offered during the course of your pregnancy and birth.
Cochrane.org is a great resource for learning about medical interventions in labor.