Induction of Labor

The phrase "Induction of Labor" refers to the artificial starting of labor. In a hospital setting, this is usually done by softening the cervix or initiating contractions through prostaglandins or oxytocic drugs. There are also natural ways to stimulate labor using herbs, homeopathic methods, acupuncture, and castor oil (castor oil really works!!).


Reasons for Induction:

Medical

• Intrauterine Growth Retardation (IUGR) where the baby isn't growing appropriately due to a failing placenta
• maternal diabetes if the baby is thought to be at too much of a risk of rapid growth and could suffer from hypoglycemic conditions after the birth
• preeclampsia that is worsening and putting the mother at risk
• Fetal distress- there are different opinions on this. Some care providers

Non-Medical Reasons- these basically fall into 2 categories:

•  Maternal Preference
• The mother may be tired of waiting, she may want a particular supporter (husband, mother, etc.) there without scheduling conflicts, or she may simply prefer that labor starts through induction. It's important for a woman to be informed of the risks of induction.

• Caregiver Preference
• again, there could be scheduling conflicts (doctor will be on vacation or out of town, etc). Caregivers may also suggest an induction if they believe it is best after a certain gestation (after 40,41 weeks for example).

How is Labor Induced?

1. Prostaglandins

• Prostaglandins are naturally in the body. They are released when we are in pain. They are also released in late pregnancy and early labor. Prostaglandins are thought to soften the cervix and prepare it for labor to begin. 
• Some of the different types of Prostaglandin medications available to artificially induce labor are Cytotec, Cervidil, or Prepidil.
•  WARNING: If you are considering a labor induction, PLEASE do not use Cytotec. It's unbelievable that this drug is even allowed to be used. Until recently, the manufacturer's own package insert warned against using it for labor induction. There are numerous harmful and dangerous risks associated with it. For more information, please read the following links:
• http://labeling.pfizer.com/ShowLabeling.aspx?id=559\
• http://www.salon.com/2000/07/11/cytotec/
• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684033/
• Prostaglandins should not be adminstered with oxytocics.

   2. Oxytocics

• Oxytocin is another hormone naturally produced by a woman's body during labor. The baby also secretes oxytocin which passes through the placenta and on to the mother to help with the labor.
• An artificial form of oxytocin called Pitocin is used to artificially stimulate labor.

What's the problem with Pitocin?

• During labor a woman's body naturally produces oxytocin on an as-needed basis- just the right doses at the right times. Pitocin actually comes from the pituitary glands of cows. I like how my doula said it- "When you're given pitocin, you're literally being given the strength to birth a calf." Pitocin is a much stronger form of the oxytocin that the body naturally produces. Therefore, it causes labor to rapidly speed up, often making contractions unbearable. 80% of laboring women found that the pitocin pains were much more intense than the sensations they felt with their natural contractions.

• Pitocin-produced contractions are stronger, longer, and closer together. The mother doesn't hardly get a break or any relief between contractions. This type of contraction can be unsafe for the baby and unbearable for the mother. Guess what the next step often is after pitocin- an epidural. Epidurals often slow down labor, leading to an increase in the amount of pitocin administered which can often adversely affect how the baby is handling the labor. Guess where that often leads- other interventions such as forceps or vacuum delivery or a C-section. This is known as the Cycle of Intervention. One small intervention leads to another, then another, and the cycle perpetuates. Fetal distress, as detected by electronic fetal monitoring, is much more common during pitocin-induced contractions.

• Pitocin may also affect the baby after the birth. Jaundice has been found to occur more frequently in newborns whose mothers received pitocin during labor. 
•  Other Risks
• Lower APGAR score
• A separate study reported that induction increased the percentage of babies born in poor condition from 16% to 21%, doubling the odds after statistical adjustment for interdependent factors.  
• Postpartum Blood Loss
• If a woman has had a previous Cesarean, the use of any labor-inducing drug (Prostaglandins or Oxytocics) can increase the risk of uterine rupture.

Other Methods of Inducing Labor

• I won't go into detail here, but you can research these methods on your own.  Here are some of the different ways: Herbal Options (black or blue cohosh), Homeopathics (cimicifuga and caulophyllum), Acupuncture/Acupressure, Castor Oil, Sex, Nipple Stimulation, and Artificial Rupture of the Membranes to name a few. 

So what's the bottom line?

Well, when it comes down to all of these methods for inducing labor- both artificial and natural- are unlikely to be very successful unless the woman's body is ready to give birth. With the non-pharmaceutical (natural) methods, the woman's body is unlikely to actually go into labor if it's not ready. They will probably have no lasting effect. With the pharmaceutical (artificial) options, since the mother is already in a hospital environment, she is likely to have further interventions if the methods are initially unsuccessful.

I'm a firm believer that a woman's body and her baby both know when it is time and that we should let nature do its job. That is the way a normal birth should be handled. Obviously, there are deviations from normal; in those cases plan accordingly.

One more thing I will say- a common reason for induction when a woman goes past 40 weeks is because "the baby will get too big." Or there is a risk of stillbirth....research has shown that risks increase only after 41-42 weeks, closer to 43. Very few women ever make it that far. There is no medical evidence to support a policy of induction carried out routinely when a mother goes past 40 weeks. Many women's due dates are inaccurately estimated for a variety of reasons. Therefore, a woman being induced at 41 weeks could actually only be 39 weeks. The majority of the time, it's best to let nature have its way.

Please check out the following links for more information:

http://www.medicalnewstoday.com/releases/243561.php

http://www.medicalnewstoday.com/articles/242393.php

http://www.theatlantic.com/health/archive/2012/03/the-most-scientific-birth-is-often-the-least-technological-birth/254420/1/

http://childbirthconnection.org/article.asp?ClickedLink=1072&ck=10650&area=27-Labor%20induction

http://briobirth.com/articles/21-scary-reasons-say-no-pitocin-according-manufacturer

http://www.whattoexpect.com/pregnancy/photo-gallery/natural-ways-to-induce-labor.aspx#/slide-1