Giving Birth: Is Induction for Convenience Safe?
My doctor has suggested an induction at 40 weeks for a variety of reasons -- all having to do with my convenience. Is induction safe enough that I can consider having it done for convenience alone?Question:
Induction of labor, accomplished for the pure convenience of mother or care provider, represents poor obstetrical practice. Induction of labor, by whatever means, holds fundamental risks to mother and child and comes at a higher economic cost as well.
The adage about the fruit not falling until it is ripe is an apt one in discussing induction of labor. If the cervix is not sufficiently prepared or ripe, no induction will be successful.
Induction for convenience should not be attempted because the risks almost always outweigh the benefits. Induction with oxytocin commits a woman to an IV, fetal monitoring for the duration of the medication administration and, most often, activity restriction in a bed or chair. Walking or taking a shower is almost always out of the question with the multiple tubes and cord involved in a typical induction.
Invalid reasons for induction include: discomfort in the last few days of pregnancy, a normal pregnancy that goes beyond the due date, a doctor who is going out of town, a planned visit by a family member, new jobs, trips and tax relief. Also, the necessity of induction has been questioned in conditions such as premature rupture of the membranes or if the pregnancy goes beyond the due date.
There are some very valid reasons to induce labor, some more critical than others. For example, a woman who has a history of fast labors may seek induction so she does not have to fear delivering at home or in transit to the hospital.
Care providers will opt to induce a mother who is, for example, hypertensive when continuation of pregnancy is seen as a risk to her health or to the baby's survival. In such cases, the benefits of induction clearly outweigh the risk in continuing the pregnancy.
Before induction, the cervix should be assessed for position, effacement, dilatation and consistency. Also, the baby's engagement should be checked. "Bishop's score," can be ascertained by assigning points to the parameters of readiness. The higher the score, the more successful the induction is likely to be.
Trends in obstetrics within the past few years have moved in favor of using prostaglandin, misoprostel, cervidil, catheter balloons, etc. to ripen the cervix prior to induction of labor. These can shorten the time of the induced labor and increase the chances that the induction will be successful.
A number of techniques have been identified which may induce labor. In some cases, artificial rupture of the amniotic membranes may lead to initiation of labor. This does not work in all women and, of course, there are risks associated with this practice. The fetal head should be engaged in the pelvis before rupture to reduce the risk of prolapse of the umbilical cord. It should only be performed by a skilled care provider who is confident about gestational age, position of the cord and of the placenta. The baby should be presenting with the head down. The cervix should be "ripe" and somewhat dilated, or effaced and in the anterior to mid position.
When artificial rupture of membranes is performed, the mother and the care provider have committed themselves to birth within approximately 24 hours. The risk of infection increases to unacceptable levels beyond 24 hours.
Pitocin (oxytocin) is the most frequently used medication in the induction of labor. All the studies on this drug have shown it be safe when used under careful medical and nursing protocols. If the woman is a good candidate for induction, then the medication should be administered intravenously in a slow progression of dosages until active labor is achieved.
Most hospital protocols dictate a schedule of routine vital signs and fetal monitoring that guides the induction process. Close observation of the fetal response to contractions and of the contraction pattern is mandatory. If the mother's body is unresponsive after several hours, and if membranes are still intact, the medication can be discontinued and restarted the next day.
Although the literature is divided on whether or not induction of labor leads to a higher incidence of cesarean birth, it is an intervention which tends to medicalize the birth process and takes control away from the mother and father.
Induction of labor when done at term (good dates, ultrasound verification), for valid reasons, under expert nursing and medical guidance is safe. Problems arise when the woman is not mentally and physically prepared for the intervention, when the baby's gestational age is in question or if skilled and attentive medical and nursing care is not available.
It is best to always seek your care provider's opinion and recommendations before attempting anything that may induce labor. Even something that seems benign can cause strong uterine contractions, which may disrupt blood flow to the baby. If a mother has had a previous cesarean birth, none of these strategies should be employed at home.
Nipple rolling, administration of enemas and castor oil have been used successfully to start labor in some women. Bowel activity and nipple stimulation cause release of the body's own prostaglandin and oxytocin. It is unlikely that these techniques will be successful, however, unless the cervix and the baby are ready.
Attempts to induce labor with herbal remedies such as blue or black cohosh or pennyroyal should never be attempted. Herbs vary in concentration and, once ingested, the result cannot be stopped. Reports of uterine rupture and intrauterine fetal stroke have been sited. Neonatal heart irregularities have also been reported.Answer: