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Monday, August 4, 2014

Informing Yourself About the Dangers of Induction Of Labor in Pregnant Women

When you are pregnant, you have a great many decisions to make. You need to think about a birth plan for yourself, you need to find the best midwife or obstetrician for your birth, and you need to consider where you want to have your baby. You also need to think a lot about your pre- and post-natal care, for example, will you have a midwife and a doula, an obstetrician and a doula, an OB only?

Will you have prenatal massages, or will you have a series of post-natal massage sessions after the baby is born to help you recover? Or will you have both? Do you understand why these decisions are important, and are you clear as to why you have made the choices you have?

In the midst of all of these decisions, you may be neglecting informing yourself about a very important decision that can have consequences for your and your baby: the decision of whether to induce labor or to let nature take its course.

It is helpful to understand that obstetricians working in hospitals are generally quick to try to get a pregnant woman to induce labor. They have a view that the pregnant woman’s body is somehow defective and will not induce labor when it is ready, on its own. However, this view is not borne out in the research, which has shown that women will labor when the time is right. (see midwifethinking for a more holistic view of birth and labor)(Also see the article on Clinic Advisor located here )

Many times when a woman has an induced labor, there are unintended consequences. The rates of caesarean sections after an induction are twice those of non-induced women. For many women today, this type of birth is undesirable. Additionally, for conditions like gestational diabetes where the baby is assumed to be very large based on ultrasounds and other monitoring, when born the baby is often underweight or premature.

Thus, many inductions were unnecessary. The problem here seems to be one of a missing feedback loop. In other words, a feedback loop would mean that: a hospital performs a certain number of inductions, many of those inductions turned out to be unnecessary or even dangerous for the baby or mother, thus fewer inductions would be performed in the future. However, this feedback loop is actually missing in most hospitals since most of them continue to perform just as many inductions, and the number is on the rise.

All of these facts are aside from the actual dangers to mothers and babies from inductions. When a woman is induced to have labor, it is an unnatural event. Thus, there is an actual risk of rupturing or tearing the uterine wall because the contractions are unnaturally strong. This leads to a higher rate of C-sections, and can also cause long term incontinence. (See this website for more information) A higher risk of post-partum bleeding has also been observed with the use of these drugs. (Belghiti J, Kayem G, Dupont C, et al. Oxytocin during labour and risk of severe postpartum haemorrhage: a population-based cohort-nested case-control study. BMJ Open 2011;1:)

With regard to the infant, brain damage, increased fetal heart rate (leading to a C-section), permanent CNS, as well as fetal death have all been reported. The rates for these conditions in the infant are higher than in those born to mothers who are not induced. In addition to these issues with newborns, they have been generally underweight or premature when born through induction, even though their ultrasounds had indicated a larger than appropriate for gestational age baby. See the pages here and here for more information.

It should also be remembered that a due date is a guess at best, since most women do not know the exact date on which they conceived. They may know the date of their last period, from which the due date is estimated. These possibilities have actually caused the American College of Obstetricians and Gynecologists to state on their own website that caution should be used when inducing labor, as quoted in the bellybelly webpage above. However, hospitals and obstetricians continue to use these procedures regularly.
In addition to the reasons mentioned, it is also helpful to note that when a woman is admitted to a hospital as being in labor, there is a time limit for that labor, regardless of what her body believes is the time limit. When that time limit has passed, the OB will generally insist on induction. When the induction occurs, if the fetal heart rate drops, or the fetus appears to be in distress, an emergency C-section will be performed. For further reading on this topic, see Ina May’s Guide to Childbirth by Ina May Gaskin, a midwife practicing since the 1970s.

It is also useful to remember that most independent midwives do not perform labor inductions. They prefer to consider the woman’s body as wise enough to know when the baby is ready to be born. The normal labor of a pregnant woman releases small amounts of induction hormones into her blood, so spontaneous uterine rupture is rare. A midwife will generally allow a woman to labor until the baby is born. Many midwives have the experience to know when a fetus is in distress, and have a hospital birth contingency plan in place before the birth takes place. (See Ina May’s book above, as well as current and past issues of Midwifery Today for further details)

Massage therapy in the prenatal period has also been shown to reduce the incidence of prematurity, as well as the incidence of complications during labor. This is another factor to consider when creating your prenatal care team. A doula is also helpful to have with you at birth, as they are another educated care provider, who can help you to be informed about the decisions you are making with your body and your baby.

The best time to learn about labor induction, using chemical or mechanical methods (such as breaking waters, which often leads to chemical induction if ineffective), is before you are scheduled to deliver your baby. Researching the possibilities will give you the best chance of having the birth experience that is best for you and your baby.

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