|
How
Induction Impacts Labor
From
October, 2007 Newsletter
Written
by Carol Peterson, ICCE, CD(DONA)
Before
beginning a discussion of induction, it is important to know that there
are times when the benefits of an induction outweigh the risks of
allowing a pregnancy to continue. In
this case, the induction becomes medically necessary.
According to the American
College
of Obstetricians and Gynecologists, medical reasons for induction include[1]:
 | A post-term
pregnancy, greater than 42 weeks.
|
| A mom with a
medical condition, such as high blood pressure or preeclampsia.
|
| Premature rupture
of membranes. (Water
breaks and labor does not start within a set amount of time.)
|
| An infection within
the uterus.
|
| An abrupted
placenta, where the placenta begins to separate from the uterine wall.
|
Be aware that a large baby is not a medical reason for induction.
According to experts, including the
American
College
of Obstetricians and Gynecologists, induction for suspected large babies
does not improve outcomes for babies and almost
doubles the risk of a cesarean for mothers.
Now,
on to How Induction Impacts Labor….
After
her 39-week appointment, Mary hurries home to tell her husband the great
news. She will be induced at 40 weeks if she hasn’t had her baby.
She is fine and the baby is fine. The
induction is really not needed for a medical reason, but she doesn’t
care. She can't wait to see
her baby, and she is growing more and more uncomfortable with each passing
day.
So,
what's the big deal?
For
those of you who have had an induction, you know that it can be a big
deal. If Mary was fully informed, she may not have agreed to the
elective induction. However, at 6:00
am Mary arrived at the hospital 40 weeks pregnant, ready for her
induction. In her childbirth class she learned that labor
usually starts with mild contractions, and the strength of the
contractions increase over time. During
her induction, Mary was shocked to find that strong contractions happened
very early in labor, that she was on the monitor the whole time, and that
her plans of using the shower and walking the halls weren't to be.
What
makes an induced labor so different from a spontaneous labor?
While
some health care providers feel that there is little difference between a
spontaneous labor and using Pitocin, a drug used to stimulate labor
contractions, most research, as well as women who have experienced
induction, contradict this. An
induced labor may result in:
|
A labor that is more intense.
Stronger contractions occur sooner in labor, without the
benefits of allowing mom time to adjust to the power of labor.
In a spontaneous labor, the ramping up of contractions gives
mom a chance to learn to cope with contractions, and her body will
slowly increase its production of endorphins to help her handle labor. |
|
A different contraction pattern.
With an induction, and use of Pitocin, the “goal” is
to create contractions that are 3 to 5 minutes apart.
To do so, the rate of Pitocin is increased every 20-30 minutes
until the contraction pattern is reached.
In a spontaneous labor, most women experience early labor where
contractions are farther apart, and eventually gather momentum,
reaching 3 to 5 minutes in frequency.
Some women experience a cluster of contractions, and then a bit
of a break, and then another cluster.
These little breaks give mom a chance to rest. |
|
Increased use of other medical technologies.
In order to keep mom and baby safe during an induction,
continuous fetal monitoring is a must.
Continuous monitoring makes it harder for mom to use other
tried and true comfort measures. Unless
mom is able to labor at a hospital with wireless monitors, she will be
confined to a limited space, unable to use hydrotherapy (shower or
tub) as a relaxation tool, and will be unable to walk, which is a
proven technique to improve progress. |
Some caregivers use internal fetal monitoring and
intra-uterine pressure catheters with an induction.
Internal monitors, inserted directly into the baby’s scalp, and
pressure catheters require mom’s water be ruptured, which creates a
commitment to delivery, increasing the chance of cesarean birth.
|
Increased
use of pain medications.
More powerful contractions, combined with the inability to use
other comfort measures, can cause many moms to choose pain
medications. |
|
Increased risk of cesarean delivery.
A recent study (2) showed that
reducing the induction rate by 22% corresponded to a reduction in
unplanned cesareans by 21%... with NO change in outcome for mom or
baby. Often, women go into an
induction without knowing that an induction will double a first-time
mom's risk of cesarean.(3) |
In
conclusion, I’ve
seen beautiful inductions that went smoothly and moms that coped amazingly
well, but I’ve also seen the flip-side of this picture.
If you are facing an induction, then I encourage you to become
informed so that you can make a sound decision, especially if the
induction is elective. It is
possible to avoid an induction, and in next month’s newsletter, we’ll
look at ways to do just that.
(1)
ACOG Education Pamphlet 154: Labor Induction www.acog.org
(2) ICAN White Paper
"Induced Labor and Informed Consent in Canada" by Gail J.
Dahl. www.ican-online.org
(3)ICAN White Paper
"Position Statement: Induction of Labor" www.ican-online.org
|
The material in this site is provided for personal,
non-commercial, educational and informational purposes only
and does not constitute a recommendation or endorsement with
respect to any company or product. You should seek the advice
of a professional regarding your particular situation.
Copyright 2007, Carol Peterson, ICCE, CD(DONA)
|
|
