Let’s talk about medical inductions!

A medical induction is when labor is started artificially rather than letting the body begin labor on it’s own. Types of medical inductions are:

• Sweeping the Membranes.
• Pitocin.
• Prostaglandin.
• Foley Catheter
• Artificially rupturing of membranes (AROM).

Typically labor induction is recommended when complications such as these arise:

Hypertension, preeclampsia, heart disease, gestational diabetes, bleeding and oligohydramnios (low level of amniotic fluid <5).

Labor is also induced if the amniotic sac has ruptured and labor has not begun within 24-48 hours. This is much shorter if you have Group B Strep. It is also induced if there is an infection present in the uterus, this is known as Chorioamnionitis.  Additionally if the pregnancy goes beyond the estimated due date of 40 weeks care practitioners tend to start putting on the pressure for induction.

An elective induction for personal reasons before 39 weeks has it’s own set of risks. For the mother an early induction could mean that she is still 3 weeks away from her own physiologic labor onset, which means her body hasn’t yet prepared the maximal number of oxytocin receptors which are necessary for a progressive and efficient labor. And for the baby there are risks such as potential breathing problems, infection, and admission to the neonatal intensive care unit (NICU). More adversely, babies who are born prematurely are at greater risk for learning and developmental challenges as much of the brain’s growth and development happen in the last few weeks of pregnancy.

The risks associated with induction in general are; potential for stronger than natural contractions or uterine activity, an abnormal heart rate of the baby over the course of the labor, a risk of uterine rupture, increased risk of hemorrhaging with Pitocin, and furthermore there is an increase in the chance of vacuum, forceps, or cesarean delivery.

As C-section rates climb in the US and Canada, researchers are looking to possible reasons for this outcome, and studies are indicating that the rise in labor inductions may be a potential culprit. Currently in the US one in three women are giving birth by C-section and in Canada it is about 26%. Induction rates in Canada climbed to 21.8% in 2004–2005 and since that time has remained steady. The reason that labor induction may give rise to a cesarean is because it is a starting point for a possible ‘cascade of interventions’. This means that once you have one medical intervention, you tend to need another and then, another.

For example, if you are administered Pitocin you will likely experience longer, stronger contractions, which are stronger then the natural contractions that the body produces. Also because the oxytocin is synthetic (Pitocin) it does not cross over the ‘brain blood barrier’, which means that the brain is not producing the beta-endorphins to help counter the pain. With the intensity of these contractions most women will decide to have an epidural. Because the epidural anesthetizes the lower body, the mind body connection is also numbed. Epidurals decrease the natural production of oxytocin; they reduce the pleasure and reward signals, and tend to slow labor down, which in turn may require an increase in administered Pitocin. Unfortunately many women plateau here, necessitating a C-section. However if the woman fully dilates, and the baby descends, the next complication is feeling the baby descend and organized pushing. Another challenge with the epidural, is that the woman is confined to her back (or perhaps side to side if she has flexible hospital staff and can keep the fetal monitor in place), which then makes pushing harder as gravity is not in her favor, creating the need for forceps or vacuum delivery.

That’s a lot to think about, I know. But I feel that the more informed we are about potential procedures and interventions the better. Medical induction used when necessary can save lives, however current research is showing us that labor induction is being over used, which is resulting in poor birth outcomes. Labor induction disrupts the natural physiological processes of labor, and can be risky for both mother and baby; it should only be used when needed.

Thanks for reading!