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Is the rush to induce labor, jepordizing the safety of mother and baby?

pregnant woman rady to deliverLabor induction (or inducing labor) is a procedure to bring on (induce) labor either because labor does not start on its own or because there is concern for the mother’s or baby’s health. In the United States, about 20% of pregnant woman undergo labor induction.  

Some people question whether medical professionals rely too heavily on induction, especially before safer alternatives have been exhausted.  There are serious risks associated with labor induction including increased likelihood of a C-section, which also has associated risks.  So, the benefits and risks of induction should be carefully weighed before a mother is induced.

In a typical pregnancy, labor usually begins on its own between weeks 37 and 42.  If labor does not begin spontaneously or there are risks to the mother or baby, labor can be induced.  Induction causes the mother’s cervix to thin out and open in preparation for vaginal birth (diagram of cervical changes).  

Reasons for induction include:

  • Post term pregnancy (> 42 weeks)
  • No contractions after water breaks
  • Water breaks too early
  • Infection of the uterus
  • Placenta is deteriorating (placental abruption)
  • Baby stopped growing at the expected pace
  • Medical condition (such as diabetes or high blood pressure) that puts mother or baby at risk
  • Practical reasons (home is far from hospital, history of quick deliveries, convenience)

There are serious risks associated with labor induction, such as:

  • Premature birth if labor is induced too early
  • Change in fetal heart rate
  • Infection
  • Umbilical cord problems
  • Need for a C-section
  • Increased risk of uterine rupture if you had a previous C-section

Methods of labor induction:

  • Dilating the cervix – medications can prepare the cervix for labor or dilators can be inserted into the cervix to widen it
  • Stripping the membranes – doctor sweeps their finger over the membranes connecting the amniotic sack to the wall of the uterus, which causes the mother’s body to release prostaglandins that soften the cervix and can cause contractions
  • Rupturing the amniotic sac (breaking the mother’s water)
  • Oxytocin – naturally occurring hormone that causes contractions

Pitocin is the brand name for synthetic oxytocin, which is one method used to induce or speed up labor (usually within 12 hours of receiving the drug).  It acts by starting or improving uterine contractions.  The drug is usually given to the mother in an IV drip.  Pitocin is not recommended for elective procedures or to speed up the birthing process for convenience.  

Instead, it is only recommended in pregnancies with a medical reason for inducing labor.  As with any other medication, there are possible side effects including: nausea, vomiting, cramping, stomach pain or more serious side effects including: irregular heartbeat, headache, dizziness, severe bleeding after childbirth, or blurred vision.  

Some people question the frequency and safety of pitocin use, especially in light of the fact that it is only recommended in pregnancies where induction is medically necessary.  A new Duke University study in the American Journal of Obstetrics and Gynecology raises questions about the use of pitoctin, showing that prolonged use of pitocin during labor and delivery is probably more dangerous than beneficial.  

The study found a link between high doses of pitocin and serious postpartum hemorrhage (excessive bleeding following birth).  Fetal monitoring is required when pitocin is used because fetal distress is more common than spontaneous labor.  The most common side effect is hyperstimulation, which means that contractions can be stronger, last longer, and be more frequent than normal contractions.  In addition, the continuous fetal monitoring requires that the mother be confined to the bed, which can make contractions more difficult to deal with, which can require pain medications.  

If there is time (no serious medical risks), it is best to try alternative methods of inducing or augmenting labor such as walking, changing positions, and nipple stimulation.  Then, if labor still is not progressing after exhausting other options, pitocin can be used to help the mother with the labor.  

It is important to remember that while labor induction and pitocin can be helpful to help labor progress or speed up if medically necessary, they should not be overused, especially for the sake of convenience.  There are serious risks associated with both, which makes it all the more important to try safer alternatives first.  

It is important that you have medical professionals that you trust, so decisions are made with the mother’s and the baby’s best interest in mind.  Some families choose to have a midwife or doula in the birthing room, so they know they have an advocate in the room.  If you think labor induction procedures or pitocin caused an injury to you or your child, you may be entitled to compensation.  

Special thanks to Heather Keil, J.D. for her assistance with this Child Injury Laws Blog entry.

Resources:

Parent Time: Pitocin – Risks and Reasons for Induction and Scheduled Births

ACOG: Labor Induction

Does inducing labor pose any threats to baby?

Mayo Clinic: Labor Induction

Medicine Net: Pitocin

Child Birth: Pitocin FAQ

Rx List: Pitocin

Drugs.com: Pitocin

About: How is pitocin used to induce labor?

US News-Health: Induced Labor Linked to Raised Risks for First-Time Moms

Indy Channel: Study Raises Questions About Childbirth Drug

Comments

  1. Thanks for highlighting this very important issue. Induction of labour almost always leads to a cascade of interventions that do a mother and baby more harm than good. I wish more people knew more about this. The suggestion of a doula or midwife (where available) is an excellent one.

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