When it comes down to it, there is an average induction rate in the US of 22% (as of 2006), it may be even higher at this point, and induction carries quite a few risks. There are a few different methods of induction, although this post is specifically about Pitocin.
How is Pitocin administered and how does it work?
Pitocin is the brand name for a synthetic oxytocin administered through an IV port into the maternal blood stream and diluted with saline ringers.
Oxytocin is naturally produced by the hypothalamus and sent to the pituitary to be released. It stimulates contraction of the uterus as well as let down (milk) and release. It is released in spurts, causing rhythmic contractions of the smooth muscles of the uterus. Naturally occurring oxytocin also enter the brain and cause a euphoric high. When synthetic oxytocin is used (pitocin), it enters the blood stream and does not cross over to the brain, hence, mom and baby are deprived of the love hormone that causes the post-birth high .
Why do doctors recommend induction?
Post Date/OverdueWe have talked before about Estimated Due Dates and what they actually mean. Some childbirth educators liken due dates to popcorn - that, just like when you pop corn, some kernels are ready and pop before the others, others pop later.
Likewise, we have talked about the error of our current obstetrical mode of determining date of 'dueness', as well as a more reliable means of establishing your estimated due date as well as how to know if you are a good candidate for a successful induction .
Big BabyThroughout history, women have birthed babies of all sizes with no issues, no complications. I know of many many women of different shapes and sizes who have birthed babies that were upper 9 and 10lbs with no issues. Late-term ultrasounds are known to be off by a pound either way, and there is no accurate way to determine how large a baby your hips can accommodate without a serious trial of labor.
Likewise, late in pregnancy, babies are gaining fat stores more than length and girth in bone structure. And the great news? Fat squishes. And, if nothing else can convince you, during a naturally occurring labor, hyaluronidase and relaxin help to loosen your joints and ligaments, including your pelvis, increasing the size of the outlet. These hormones are missing in an induced labor.
Old PlacentaAlso known as calcification of the placenta , this is when the placenta begins to show it's age by calcium deposits showing up as white spots on the surface of the placenta. This is very common toward the end of pregnancy and, in most instances, does not inhibit the safety and health of the baby. A care provider may monitor baby more closely to make sure that growth is not restricted as a result.
PROM (Premature Rupture of Membranes)The rule of thumb is this: if your water breaks without contractions, you have a 12-24 hour window in which to deliver your baby before the risk of infection sets in. In reality, there is a large body of evidence to show that induction for this reason alone is not justification , as infection rates do not increase substantially enough during this window. In addition, there are a great number of women whose leaks reseal themselves or end up being 'surface leaks' and not true amnion breaking. Spontaneous labor occurs in 85% of women within 24 hours and in 95% of women within 72 hours.
To further decrease the risk, there are other steps a woman can take. These include: her GBS status (GBS negative, automatically there is a lowered risk for infection), vaginal exams (the less vaginal exams administered, the less risk of infection), and hydration (a woman who remains hydrated has less chance of having a 'dry birth' (although there is no such thing) and less chance of infection as amniotic continuously acts like a natural douche, pushing bacteria out of the vagina) to name a few. A great study on PROM and infection risk can be found here .
Infectious morbidity may be more influenced by the interval between vaginal examination and delivery rather than between rupture of membranes and delivery. “It would seem that the clock starts ticking after a vaginal exam,” she added.Another issue is to consider this: a woman who has S/PROM at 30 weeks would be closely monitored for infection and given plenty of fluids... hoping to avoid infection and possibly even reseal the leak. The benefits outweigh the risks of induction at this point. Nothing changes 'at term' except that you are now 'at term'.
Other ConditionsOther reasons commonly given for induction may include Gestational Diabetes, infection of the uterus, Pre-Eclampsia, diabetes, hypertension, or other conditions. When these complications present themselves, look into the risks and benefits of both an induction and the possible risks of waiting-and-seeing.. then make an educated decision for yourself.
Risks of Induction
One of the most comical, but accurate, media representations of these risks can be found on the Business of Being Born, and seen below
Some of the risks they touch on in this excerpt
So, now that we know the how, the why, and the risks.. how do we avoid the pit?
Education and rights. Know your rights and your risks. Know your Bishop's Score to make a more informed choice whether you are truly ready to birth your baby or not. What reasons are your care providers giving for induction?
Prepare your body for naturally occurring labor and birth before the last trimester by remaining active throughout your pregnancy, eating a healthy, balanced, and whole foods diet, reducing chemical interference and salting your food to taste. Educate yourself to the benefits of using Evening Primrose Oil for cervical ripening and Red Raspberry Leaf Tea for uterine tone.
I give this information not to condemn the choice of induction, but to fully inform and educate so that women (and partners) can make the best choices for their situations. There is to flippant an attitude in our obstetrical model of care to the risks and implications of forcing nature's hand. Be educated.
For further reading OBGYN.com
March of Dimes. (2006). If you’re pregnant: Induction by request. Retrieved September 21, 2007, from http://www.marchofdimes.com/prematurity/21239_20203.asp
March of Dimes. (2006). Late preterm birth: Every week matters. Retrieved September 21, 2007, from http://www.marchofdimes.com/files/MP_Late_Preterm_Birth-Every_Week_Matters_3-24-06.pdf American College of Obstetricians and Gynecologists [ACOG]. (2004). ACOG Practice Bulletin No. 55: Management of postterm pregnancy. Obstetrics and Gynecology, 104(3), 639-646.
Ben-Haroush, A., Yogev, Y., Bar, J., Glickman, J., Kaplan, H., & Hod, M. (2004). Indicated labor induction with vaginal prostaglandin E2 increases the risk of cesarean section even in multiparous women with no previous cesarean section. Journal of Perinatal Medicine, 32(1), 31-36.
Condon, J. C., Jeyasuria, P., Faust, J. M., & Mendelson, C. R. (2004). Surfactant protein secreted by the maturing mouse fetal lung acts as a hormone that signals the initiation of parturition. Proceedings of the National Academy of Sciences of the United States of America, 101(14), 4978-4983.
Cunningham, F. G., Leveno, K. J., Bloom, S. L., Hauth, J. C., Gilstrap, L. C., & Wenstrom, K. D. (2005). Williams obstetrics. (22nd ed.). New York : McGraw-Hill.
Glantz, J. C. (2005). Elective induction vs. spontaneous labor associations and outcomes. Journal of Reproductive Medicine, 50(4), 235-240.
Goer, H., Leslie, M. S., & Romano, A. M. (2007). The Coalition for Improving Maternity Services: Evidence basis for the ten steps of mother-friendly care. Step 6: Does not routinely employ practices, procedures unsupported by scientific evidence. Journal of Perinatal Education, 16(Suppl. 1), 32S-64S.
Kramer, M. S., Demissie, K., Yang, H., Platt, R. W., Sauve, R., & Liston, R. (2000). The contribution of mild and moderate preterm birth to infant mortality. Journal of the American Medical Association, 284(7), 843-849.
Tanner, L., & Associated Press. (2000, August 16). Death risk higher for preemies: Study reassesses danger for those born just a few weeks early. Dallas Morning News.
Vahratian, A., Zhang, J., Troendle, J. F., Sciscione, A. C., & Hoffman, M. K. (2005). Labor progression and risk of cesarean delivery in electively induced nulliparas. Obstetrics & Gynecology, 105(4), 698-704.
Wang, M. L., Dorer, D. J., Fleming, M. P., & Catlin, E. A. (2004). Clinical outcomes of near-term infants. Pediatrics, 114(2), 372-376.
And all linked sources throughout this article.