Inducing Labor

There are a very few instances when inducing labor is the best option (only if safer for the baby to be born right away. This is a complicated choice.)

For the vast majority of women it increases risks for them and for their babies. Induction leads to what is called a "cascade of interventions" meaning that one intervention follows after another after it begins.

Researchers are not sure exactly what decides that labor should begin. Some research has shown that it may be the baby's brain that is responsible for naturally inducing labor. No matter how it starts, it's a complex interplay between your body and your baby's body.

Each and every day is valuable to your baby and to your body. Your baby grows and develops more for birth every day during late pregnancy. He or she is putting on more fat and his or her lungs are developing more with the passing time.

Your body also prepares for labor every day in late pregnancy. You could even be dilating a few centimeters without having to labor hard for it!

Methods of Inducing Labor Chemically and/or Forcefully

Forceful "Natural" Induction

Breaking the Water

Modern obstetrics makes breaking the water (called amniotomy) seem like a simple, routine procedure. However, allowing your water to be broken changes the course of your labor - and it places a time limit on your labor. If you are in a hospital or using a midwife who must adhere to certain regulations, you may have as little as twelve hours from the time your water breaks to have your baby!

Having your water broken to "speed up labor" is not usually justified. Studies show that amniotomy speeds up labor by only 30-45 minutes. Sometimes it does help get a sluggish labor moving, but movement and drinking plenty of fluids has been shown to be about as effective.

As a method of inducing labor, 70-80% of women will start labor within about 24 hours. The rate of uterine infection is much higher for that 20-30% of women who do not.

In fact, choosing induction by amniotomy increases the risk of uterine infection to all women. If you're having your water broken, or if you water has broken on its own, avoid having vaginal exams done. Each exam increases your risk of infection.

Breaking your water removes the cushion of water surrounding your baby's head. Both you and your baby will feel more pressure, and many researchers believe that it is safer for the baby and for the mother to have an intact bag of waters during most of labor. You should expect stronger contractions and a harder labor if your water is broken.

If your baby's head is up high when the water is broken, there is a risk of cord prolapse. This means that your baby's umbilical cord falls between his or her head and your pelvis/cervix. This is a life-threatening situation that requires an emergency cesarean section (usually performed with someone's hand in your vagina to hold the baby's weight away from the cord).

Sweeping the Membranes

The bag of water is attached to the side of your uterus. When someone "sweeps your membranes," it means that a finger is run lightly along the inside of the cervix to separate the amniotic sac from the wall of the uterus. Often you'll be told that labor will start within a couple of days. In reality you may be pregnant for a few more weeks.

There is a chance of infection if you allow your care provider to sweep (or "strip") your membranes. There's also a chance it could do nothing more than give you a miserable backache. If you are nearing 42 weeks this may be something you decide to allow. Just remember that it is an intervention and it does increase the risks of infection.

Inducing Labor Chemically Requires Intervention

Synthetic Oxytocin

If you agree to a medical induction you are agreeing to a host of interventions. First and foremost, a chemically induced labor is very different from a natural labor.

Labor that's induced with synthetic oxytocin (Pitocin) is stronger than natural labor. Your contractions will be stronger and peak more quickly. Your uterus stays tense even between contractions - the stress on your body and your baby never completely relaxes.

Because of this increased stress continuous monitoring is required. This is called electronic fetal monitoring (EFM) - when you must have it continuously you are often stuck in a bed with a belt around your belly.

Alternately and more painfully an electrode could be screwed into your baby's head. This provides a continuous record of your contractions and your baby's heart rate. The EFM printout tends to be very open to misinterpretation and directly increases your risk of cesarean section.

The added stress on your baby makes it more likely that he or she will pass meconium (the first stool) in the womb, opening up the possibility of aspiration (meaning it gets into his or her lungs.)

Your baby will also have a higher probability of jaundice if you are induced. A cesarean section gives your baby a much higher chance of being born with breathing difficulties because there has been no pressure on the chest to help squeeze fluids out of the lungs.

You'll have to have an IV running after inducing labor chemically. This is painful, limits your mobility, and can cause an excess of fluid in your body. When coupled with EFM, an IV pretty much guarantees that you'll be stuck in bed and unable to work with your labor.

Having Pitocin also changes the immediate postpartum period. Your body doesn't release all the hormones it should (because the Pitocin interrupted your normal hormone release pattern). This can cause problems because your body hasn't released all the hormones that make you and your baby alert and aware.

Your baby may also be less responsive which prevents him or her from behaviors that benefit both of you. Newborns are naturally alert and aware. They make movements that stimulate your body and they naturally attempt to latch on and nurse shortly after birth. This gets hormones surging in your body that help you to recover from birth.

Prostaglandins

If your care provider wants to try inducing labor by putting something against or on your cervix, he or she will be using a prostaglandin. Prostaglandins are produced by the body and help to soften and "ripen" your cervix. The synthetic forms are usually in a gel, a caplet, or a tampon-like applicator.

In the United States, two brands of synthetic prostaglandin are approved for inducing labor (Prepidil and Cervidil). There is another drug, called Cytotec, which is a "favorite" for labor induction. This drug has never been approved for this use - in fact the manufacturer warns against using it when inducing labor!!!!

There have been disastrous outcomes associated with Cytotec used for inducing labor - including uterine rupture, baby death, and maternal death. The manufacturer warns that Cytotec can "cause abortion." The drug is made to help with ulcers, not labor. Mother Jones Magazine has an eye-opening article about Cytotec for inducing labor you should read.

Prostaglandin induction brings with it many of the same worries that synthetic oxytocin induction does. It causes hard uterine contractions that are stressful on you and the baby. Your baby is more likely to pass meconium in the womb and more likely to be jaundiced. There is a higher incidence of fetal distress.

Preemies

A NICU (neonatal intensive care unit) visit is not unusual for a baby whose mother was induced. In fact, chemically inducing labor brings with it a new term - iatrogenic prematurity - meaning "doctor caused" premature birth. The term was created because of the rising rate of induction and the correlating rise in premature births.

Doctors cannot always be sure of when a baby is "due." And some pregnancies normally go past 40 weeks. In the past, such a thing was not considered unusual. Don't let a doctor pressure you into inducing labor that you and your baby are not ready for.