By Rosemarie Gonzalez, MSC, MFC
"When we become so confident has to believe that we can reproduce and redesign such a complex events as birth, we are assuming that we can, indeed, play God." Nancy Wainer Cohen & Lois j. Estner
There has been a rise in labor Induction in recent years and it is becoming more common. There are mixed reviews and studies when it comes to labor induction, making it difficult for women to make informed choices during labor and birth. Induction of labor should not be taken lightly as inducing labor may have an effect on a birthing woman and her baby.
Induction of labor is defined as the use of procedures to bring on labor. Procedures include rupturing the membrane, the use of Pitocin, herbal tinctures and medications. Each procedure has its own risk. It is important that women are made aware of these risks to be certain she is making an informed choice for her and her baby.
Intervention such as induction procedures should only be used when it is medically necessary. Many times I have read, heard and seen situation where an unnecessary intervention such as those used during induction creates an emergency that may have never been if the labor and/or birth were not tampered with.
Many of these induction methods carry risk as well. For example, rupturing the membranes can lead to increased risk of infection. Since this procedure is done by the Dr. or Midwife separating the amniotic sac from the uterine wall it can introduce bacteria to the uterus. It can also increase the possibility of premature birth as there have been cases where weeks of pregnancy have been off by as much as 4 weeks. Any induction increases the risk of premature delivery. And any induction can increase a women’s risk of having a cesarean section. If the body is not ready to birth the baby, induction can fail leading to cascades of interventions that may eventually lead to a cesarean section, as some interventions have been known to have an effect on the baby’s heart rate.
Some people believe the use of certain herbs, homeopathic remedies and tinctures to be a more natural way of induction. But this can also have an effect as some of these remedies can affect the baby’s heart rate as well. Some may also dehydrate the laboring woman if she is not keeping hydrated during the use of such remedies, as contractions may come about too strong.
There have been times when women are induced before full term without a true medical indication. This is not evidence base practice. It is stated in The American College of Obstetricians and Gynecologists[i] that "The College and SMFM have long recommended that doctors not induce labor or perform cesareans before 39 weeks of pregnancy without a clear medical reason. A full-term pregnancy lasts 40 weeks. “Early-term” deliveries are those that occur between 37 and 39 weeks of gestation". So why are so many inductions and c-section being done before the recommended weeks and some for non-medical reason?
In many cases when birth is left alone, women do just fine and can deliver naturally. “Nature is not perfect. However, when it comes to babies and birth, unless there is a clear medical indication that induction of labor will do more good than harm, nature beats science hands down. For both mothers and babies, it is safe and wise to wait patiently until labor begins on its own” (National Center for Biotechnology)[ii]. In my experience, an augmented labor can bring on even more pain and makes it harder to concentrate and cope with what is happening within the body. “In normal labor, oxytocin is released in the brain. When oxytocin reaches a high level, endorphins are released. Endorphins, the body's natural pain-reducing hormones, help women cope with labor pain. Pitocin given through an IV does not reach the brain, so there is no release of pain-reducing endorphins”(National Center for Biotechnology)[iii]. Naturally the body copes with what it gives. But how can it cope with what someone else is giving it? This can make for a much harder and difficult birth when it is not needed, but without true evidence based care and true support to remind women of that, it may be difficult to labor without interventions, which is why some women at this point choose to have an epidural to help ease the pain the Pitocin has caused. This may lead to a cascade of interventions.
When interventions that is made to seem like it would make normal birth seem easier, it is hard to turn away from how appealing that sounds during vulnerable moments. But I am sure if more women understood the risk involved, including what are true medical reasons for inductions, their choices would be made according to the evidence provided and not based on opinions and possibly others convenience.
As birthing women it is important to research all of our choices in birth, so that we are certain the choices made are what is best for ours and the baby's well being. It is as equally important for our laboring support team to be just as informed and do some research as well. True support is based on a laboring woman’s wants, needs and the evidence behind what is being presented.
It is important to have true support during labor regardless of where one decides to birth. Support can mean different things to a laboring woman. However, a true labor supporter would know and understand just what the laboring woman would need just by paying attention and listening to her before, during and after birth. I love the stories given in Nancy Wainer Cohen & Lois j. Estner book, “Silent Knife” (pg. 233-234)[iv], regarding labor support. “Support does not necessarily imply agreement, nor does it always mean physical assistance. The way we support, touch, and care for others stems from aspects of our own personalities, including how we ourselves have been supported. Each individual relationship manifests its own nurturing behavior” (pg. 233).
I realized how important it is to have true support during pregnancy, labor and birth when I was pregnant with my fourth baby. At around 39-40 weeks pregnant I felt the pressure around me to have my baby already. I felt like me waiting for my son to be born was disrupting the lives of others as others were waiting as well. However, my husband remained positive with it all which helped me to keep as relax as I can. Because of my experiences I began to see how some women get pressured to induce for non-medical reasons during such a vulnerable state. But with my husband’s support, I remained focused.
Many women need renewed confidence in their true laboring abilities through true support and evidence based care to make appropriate choices for themselves and their babies.
[i] The American Congress of Obstetricians And Gynecologist, “Early Deliveries Without Medical Indications: Just Say No”. Society for Maternal-Fetal Medicine 2013
[ii] Lothian, Judith A., PhD, RN, LCCE, FACCE, The Journal of Perinatal Education Advancing Normal Birth, “Saying “No” to Induction.J Perinat Educ. 2006 Spring; 15(2): 43–45.
[iii] Lothian, Judith A., PhD, RN, LCCE, FACCE, Amis, Debby, RN, BSN, CD (DONA), LCCE, FACCE, and Crenshaw, Jeanette, RN, MSN, IBCLC, LCCE, FACCE, The Journal of Perinatal Education Advancing Normal Birth, “Practice #4: No Routine Interventions”. J Perinat Educ. 2007 Summer; 16(3): 29–34.
[iv] Cohen, Nancy Wainer & Estner, Lois J. (1983). Silent Knife. South Hadley, Mass: Bergin & Garvey Publishers, In
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