Induction (the Big Push)

Recently I was asked to post the differences between most OB hospital births verse midwife home births. I have been thinking about this topic and contemplating what that looks like. I will be looking at Induction/Augmentation in this post.

Planned hospital births/OB push for induction between 39-40. Argument for your placenta will stop working. Your baby will be to big. Your body won’t go into labor without help. Your care provider is going on vacation and won’t be on call after 40 weeks. ACOG says babies need to come after 39 weeks. (Facts: You are not post dates until after 42 weeks. Good nutrition helps the placenta to provide for baby’s nutritional needs until delivery. You will go into labor when baby is ready and he releases hormones to stimulate oxytocin production starting contractions. Good nutrition helps your body grow the right size baby. Your body was made to grow, deliver and feed your baby.)

There are different forms of induction: Foley catheter, breaking of one’s water, Prostaglandins (cytotec/misoprostal), oxytocin (Pitocin), or stripping of membranes each of these have potential for complications: infection, uterine rupture, fetal distress, cesarean, or death.

I will touch a bit on the use of prostaglandins and synthetic oxytocin. Inductions are usually started with misoprostal/cytotec to ripen cervix – women are told it does not cause or enhance contractions. Another method used for induction or augmentation is Pitocin which can cause brutal, long transition style contractions from onset. However, these medications are used to create contractions to stop postpartum hemorrhage. Both of these methods can cause fetal distress from insufficient oxygen. Women sometimes are not able to cope with the contractions pain, intensity, pattern, or duration and they seek relief in the form of an epidural. (Fact: Natural labor contractions are not as intense or as long as medicinal enhanced contractions. Labor has a natural ebb and flows meaning contraction will become stronger and closer as oxytocin levels increase followed by a period of spacing out and less intense as endorphins are released. This cycle is repeated numerous times until the delivery. This is the body’s mechanism for coping with labor.

When an induction is done, other interventions are also included in the package: IV fluids started, continuous external fetal monitoring or internal fetal monitoring, clear liquid diet is enforced. Between IV lines and fetal monitoring one can feel tied down. These limit movement which can increase one’s stress. As one’s stress increase so does the release of adrenaline causing labor to become dysfunctional and more painful. The pain fear cycle has been initiated. (Fact: Fear increases pain which in turn increases fear. The same is true with the more one relaxes the less one feels pain allowing for more relaxation.)

Many hospitals have determined the timetable for labor, dilation, ruptured waters, or intensity of contraction before additional interventions are encouraged, forced to get the baby out. Causing a complication increases the pain fear cycle, which causes the need for greater interventions this has lead to the increasing cesarean rates within our country. This timetable reduces or eliminates informed consent because panic or injury to baby reason is given and many women are making decisions out of fear not knowledge. (Fact: Complications can and do happen no matter the birth setting. However, fewer complications arise when fewer interventions being are given.)

Any birth can range from pleasant, ideal, informed and satisfying for the woman to a night mare because of attitudes, interventions, procedures done without consent, outcome of delivery. To plan for the birth that best meets your desires and goals interview your prospective provider with a plethora of questions. IF your current provider is not answering your questions, blowing you off, using fear to motivate, inadequately skilled for different complications change provider. It is never too late to find someone that respects, listens or informs you with your options and possible outcomes. You should give birth in the setting you feels safest with whom you desire to attend you. You should be educated with the facts of safety, the outcomes, and skills for given complications by your provider allowing you to determine if your provider’s knowledge and skill base will meet you expectant needs and desires.