What Are Some Medical Reason To Justify Induction
There are a number of medical reasons an induction is necessary. Here are just a few:
- When a complication develops such as: hypertension, preeclampsia, heart disease, gestational diabetes, or bleeding during pregnancy.
- If the baby is in danger of not getting enough nutrients and oxygen from the placenta.
- The amniotic sac has ruptured but labor hasn’t started within 24-48 hours.
- The pregnancy is prolonged beyond 42 weeks with possible risk to the baby from a gradual decrease in the supply of nutrients from the placenta.
- There is an infection inside the uterus known as chorioamnionitis.
What Are The Risks Of Non-medical induction?
It's tempting to induce to accommodate a busy schedule or to ensure family members are present for the birth. And sometimes you get misleading information that can complicate matters. For example, you may be told that your baby is "too big" and encouraged to induce -- or risk a c-section. However, you should still weigh your options carefully, cautions Mildred Ramirez, MD, associate professor at the University of Texas Health Sciences Medical School at Houston. Most of the time, ultrasound isn't accurate in predicting fetal weight. Your chance of having a c-section because you're inducing before your body is ready is about the same as having a c-section because your baby truly is too big, she explains.
My personal experience:With each pregnancy I was told I would have a huge baby. But with my 5th child that this baby was off the charts huge. That it was so big the ultrasound machine couldn't measure him because the numbers didnt go that high. I was also told that I would most certainly break hospital records and that at this rate he was sure to be 13 plus pounds. I was told about possible complications due to size like him getting stuck and causing shoulder dystocia among other things. And of course talk of an emergency c-section happened too. Long story short, there were no complications at all with his delivery. He was out in about 4 pushes and I was only 8cm when he came out. He weighed 8 pounds 11oz which is on the smaller end for my kids. Most of mine were close to 10 pounds. In conclusion, our bodies typically don't make babies larger than we can birth. Although it does happen, it is very rare to not be able to deliver a baby because of size alone.
What Are The Different Methods Of Induction
1. Medications
Prostaglandin: Suppositories are inserted into the vagina during the evening causing the uterus to go into labor by morning. One advantage to this method is that the mother is free to move around the labor room.
Oxytocin: The body naturally produces the hormone oxytocin to stimulate contractions. Pitocin and Syntocinon are brand name medications that are forms of oxytocin. They can be given through an IV at low doses to stimulate contractions.
What are the advantages of taking oxytocin? Oxytocin can initiate labor which might not have started on its own, and it can speed up the pace of labor.
What are the concerns when taking oxytocin? Labor can progress too quickly, causing contractions to become difficult to manage without pain medication. Oxytocin may need to be discontinued if contractions become too powerful and close together.
2. Artificial rupture of the membranes (AROM)
When the bag of water (amniotic sac) breaks or ruptures, production of prostaglandin increases, speeding up contractions. Some health care providers might suggest rupturing the amniotic membrane artificially.
A sterile, plastic, thin hook is brushed against the membranes just inside the cervix causing the baby’s head to move down against the cervix, which usually causes the contractions to become stronger. This procedure releases a gush of warm amniotic fluid from the vagina.
What Will Induced Labor Feel Like? And What Are The Risks?
As mentioned above, labor is usually brought on fast and hard. If you were looking for an unmedicated labor and birth, this will lower the chances of that. However some have still managed to have a natural delivery despite having been induced.
Keep in mind that everyone responds differently to induction. And no two inductions even with the same mother is the same. Im a perfect example of that. With my first son it wasn't so much an induction, but I was given pitocin to augment my labor and help it progress. While in labor I was checked by a nurse who told me I was 9cm. I was almost ready to push and had been drug free up until this point. There was a shift change and a new nurse checked me. She told me I had gone back down to an 8. (Looking back now I realize that different people have different ways of estimating how dilated you are. So I was probably still a 9) After being told I went back down to an 8 I was so discouraged. I was exhausted after being in labor for over 21 hours. I was told pitocin would help me progress and it seemed very appealing to not be in labor for much longer so I agreed. I did 21 hours of labor unmedicated and was still going strong. But as soon as the pitocin hit my system the pain was off the charts intolerable for me. With normal contractions they start of small and gradually get stronger and peak and then come back down. You usually get some time between contractions to rest and catch your breath but with pitocin it was totally different. They came on hard and fast already peaking from the start. They didnt come in waves and they didn't back down or have any time between contractions to rest. It was one on top of another. I couldn't handle it. I asked for an epidural. An hour or so later my son was born. I regretted that epidural even to this day. Its just another classic example of how one intervention leads to a domino effect of other interventions and possible issues. Below you can see my personal series of events but some can lead to much bigger interventions like C-sections and more.
But like I mentioned before, everyone reacts differently to inductions. I was also inducted with my last child. I was already past due and based on my medical history we thought it best to not go to 41 weeks. I was induced at 40 weeks and 3 days. I was not in labor at all and this was a true induction.
I was definitely concerned about all the other possible interventions and complications that could come up but I chose what I felt was the best option given the circumstances. This birth was actually the easiest out of all of my 5 births. I was able to sleep through most of the labor. The contractions were not out of control. I progressed nicely. I had no complications and I was in fact able to deliver without medication. Did I know that was going to happen? No. What it comes down to is are you willing to risk it. Had I not been past due I wouldn't have. But all of our stories and medical history are different and you have to weigh the pros and cons yourself.
When it comes to breaking the bag of water there are a few things you should keep in mind. Once the bag breaks, artificially or naturally, you and your baby are now susceptible to infection. I usually like to keep the number of vaginal exams to a minimum regardless but even more so after your water has broken. The more hands that go up there, the bigger the risk of infection. Also, most doctors will put you on a timetable after your water breaks. Usually its 24 hours. So after your water breaks you will have 24 hours to deliver your baby. If you don't then they will want to do whatever they can to get it out, weather that means augmenting the delivery with pitocin or something similar or as a last resort a c section. If you want to be left to labor at your own pace then artificial rupture of your membranes is a big NO. Of course if it breaks on its own then you sort of have to go with what you were dealt. And you def do not want to have your water broken early on. It makes no sense in breaking the waters prior to 7cm or so at least in my opinion. Maybe even a 6 if you have been stuck there for several hours with no progress. But even then they should do other methods of augmenting labor prior to breaking the waters. But breaking it any sooner is just asking for some sort of complication and intervention. I can't imagine any medical professional doing it before then.
What About Inducing For Non-medical Reasons?
Thinking about inducing because your doctor's vacation coincides with your due date or you're just plain tired of being pregnant? According to the Centers for Disease Control, almost 25 percent of all inductions are elective, or not medically necessary. Choosing to induce labor for nonmedical reasons is a hot topic among experts and moms alike.
The American College of Obstetricians and Gynecologists doesn't recommend induction for nonmedical reasons before 39 weeks. Any earlier, and you risk bringing your baby into the world before he/she's developmentally ready. "Induction is a medical procedure that carries risks, so it should be reserved for medical reasons only," says Sabine Droste, MD, associate professor of obstetrics and gynecology at the University of Wisconsin-Madison.
You Are Allowed To Ask QuestionsYou are the patient and you have hired the hospital and their staff to help you with your labor and delivery. Remember that. You are paying them. Sometimes we forget that we have a choice and a voice. Do not be afraid to decline something youre not comfortable with. Do not be afraid to ask questions. Do not be afraid to ask for alternatives.
The following questions can be helpful when you do not understand or feel comfortable with suggested interventions:
- Why do I need this procedure?
- How will it help me and my baby?
- Are other options available? If so, what are they? What are the risks?
- What are the risks if the procedure isn’t done?
- What are the risks of delaying the intervention for an hour?
