Saturday, August 15, 2009

The Seduction of Induction

As a doula, I have to be up to date on all the statistics, findings, pros, cons, and all the other information out there on induction of labor. According to statistics, induction of labor accounts for42% of all births (research done by I think it is important to point out that in most cases their is no evidence of better maternal or neonatal outcomes with induction of a normal, healthy mother and baby.

The most common methods of inducing of labor are done by introducing a synthetic hormone called Pitocin into the bloodstream through a continuous IV drip or by inserting a prostaglandin suppository into your vagina for cervical ripening. Each of these methods is usually followed by the artificial rupture of membranes. If you are scheduled for an induction, I recommend that you do all of the research you possibly can about what is involved. In most cases, many other interventions will follow that you may not understand or wish you knew more about.

Note: The decision to have an induction could be the last decision you make about your birth.

In her talk, Penny Simkin raised the question, "Are there repercussions from interrupting normal pregnancy and bypassing the normal birthing process?"

ACOG (American College of Gynecology) states that induction is okay for the purpose of medical reasons such as illness, oligohydraminios (low amniotic fluid), post dates, prolonged PROM (premature rupture of membranes), IUGR (intrauterine growth restriction), and *M.D. decision on a case by case bases. ACOG is now silent on induction of "big baby" as of 2009.

*I personally feel that this leads to a wide variety of interpretation by doctors and their patients.

Now on to Macrosomia or better known as the "big baby" theory. How many of you have been told were going to have a large baby, only to give birth and find out they were overestimating by pounds? A "big baby" is classified as being suspected to weigh 8.5 lbs. or larger. I say "big baby" with quotes because there is truly no way to tell how much a baby weighs while in utereo and the ultra sound can be off by as much as 10%. "Big baby" is a relative term. Often times there is fear associated with inducing for a suspected "big baby" such as shoulder dystocia or further baby weight gain throughout the remainder of the pregnancy. Shoulder dystocia occurs in only about 30% of babies over 8.5 lbs. and it is also important to know that SD can occur in babies of all weight and size. Furthermore, induction for "BB" does not prevent a cesarean delivery, nor does it improved the outcome of mother and/or baby.

The reasons for induction vary across the board. I do not advocate all of these. In fact, I am highly opposed to many of these. But, I am not opposed to induction as a medically necessary procedure when absolutely necessary. Here is a list of reasons. I will let you decide what sounds like a "good" reason for induction.
  • A mother is between herpes outbreaks
  • She had a previous rapid labor
  • She and her partner are a long distance from their birth place
  • The father/partner must leave home for an extended period of time (i.e. military)
  • The mother is at or near term. Why not go ahead and just induce?
  • She wants her caregiver to be the one to deliver her baby
  • They are scheduling her induction to ensure adequate hospital staff
  • The parents want to choose to avoid or coincide with a specific date
  • Suspected "big baby"
  • The baby is post due
  • The mother has an illness
  • There is low amniotic fluid and the baby is at risk
  • There is prolonged PROM (premature rupture of membranes)
  • The baby growth is being restricted by an unpreventable cause IUGR (intrauterine growth restriction)
  • M.D. decision on a case by case bases.
Remember: You are the consumer. The illusion of control can be very alluring.

Because induction of labor is so widely practiced now, and you may have many friends who have had an induction, it is important to understand the issues involved and how to have a conversation with your caregiver regarding this topic. Many women are not aware that induction, in a majority of cases, is an elective procedure. You need to understand the difference between a medically indicated and an elective induction. It can be very difficult to resist the offer of an induction to the "ninth month woman". Induction becomes a "hurry up and wait" process. You will be restricted from food and drink, possibly for many, many hours during this process. Also note that when you choose an induction, you are also choosing to have an IV and continuous fetal monitoring because of the risks involved to you and the baby. And, you may be told to call ahead of your scheduled induction because the unit is too busy to take you on until later that day or the next. This can be very unsettling and emotional for the women who has been told that her induction is "medically necessary". Here are some suggestions to ask your caregiver when deciding on an induction.
  • Is there a problem? How serious is it? How urgent is it that we induce? What are the next steps if we hold off on the induction?
  • Describe the induction procedure. (Often times they will give you a hand out that explains it all. I highly recommend you get it straight from the mouth of the caregiver.)
  • What are the risks?
  • What are the alternatives?
  • What if my induction fails?
Because I love what I do, I work with women who have inductions. It is part of today's birth world. Again, my main focus is getting my clients educated and informed about making decisions that are right for them at the place where they are.

Thought: I agree with Penny Simkin, birth should be seen like the weather.


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