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| Medical Reasons to Induce Labor What is the Bishop Score? Inducing Labor With Drugs Inducing Labor Without Drugs The Downsides of Induction Risks of Inducing Before 39 Weeks Gestation Important Note About Inducing Labor | |
 When a woman and her caregiver decide to induce labor, no matter what the reason, they are making a decision to start the labor process before the body would otherwise have done so. Sometimes it is absolutely the right thing to do in order to preserve the health or life of the mother and/or the baby. But inducing labor is interrupting what nature would have done on its own, and can pose risks to the mother and baby. Read all you can about egging on a baby's entrance into the world so you can make an informed decision that won't leave you feeling disappointed with your choice. Two factors should be strongly considered when deciding whether to induce labor: 1. Is it medically necessary? 2. What is the mother's Bishop Score? Medical Reasons to Induce Labor You might think it's a great idea to be able to start your labor whenever it's convenient, or because you're just tired of being pregnant, or so that certain family members can be there for the birth. But the makers of Pitocin and Cervidil, two common labor-inducing drugs, both state that their drugs are only to be used in cases where there is a medical reason to induce labor. In other words, labor is not to be induced with these drugs strictly for the convenience of controlling the time of your baby's birth. So what are some of the medical reasons to induce labor? According to the American College of Obstetricians and Gynecologists (ACOG), an induction would be medically necessary if you:
We often hear pregnant women say that they are going to be induced for NON-medical reasons, where they schedule what is known as an elective induction. They might say:
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| The Downsides of Induction | |
Any medical intervention or drug prescription has benefits and risks. The same goes for the drugs used to induce labor. According to ACOG, inducing labor can be complicated by:
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According to the makers of Pitocin, the following adverse reactions have been reported in some mothers who used Pitocin:
The makers of Pitocin report the following adverse reactions in the fetus or neonate due to either induced uterine motility or to the use of oxytocin in the mother:
 One of a woman's greatest assets in labor is her ability to move: to walk, change positions, rock, squat, lunge, shower and bathe. Once a labor-inducing medication is introduced, it can restrict her mobility. That's because medical guidelines require an IV and/or the continuous monitoring of the baby's heart rate and the mother's contractions. Those monitors are placed on the mother's belly and are connected to equipment next to her bed, meaning that she can't travel too far from the bed or the monitors. Two other downsides to having a drug-induced labor: pain and cesareans. When labor is induced, the contractions can come on very intensely, prompting the mom to understandably opt for an epidural to relieve the pain of the strong contractions. In some cases, a laboring mother's chances for a cesarean increase after an epidural. The two drugs discussed so far, Pitocin and Cervidil, were created for and have been approved by the Food and Drug Administration (FDA) as labor-inducing drugs. A third commonly-used drug, Cytotec, was not developed nor has it been approved by the FDA, for use as a labor-inducing drug. Now manufactured by Pfizer, Cytotec is a prescription drug for people who have ulcers. It has been used as a labor-inducing drug for over a decade, despite the evidence that it can cause and has caused severe complications, including death, when it is used in this off-label way. In 2000, the head of Searle, who manufactured Cytotec at that time, sent a letter to medical professionals to let them know that Cytotec should not be used as a labor-inducing drug. Yet, despite the company's warnings and letters to the FDA from medical professionals opposing its use as a labor-inducing drug, it continues to be widely used by obstetricians and midwives because of its low cost and its effectiveness in inducing labor. Pfizer's own patient-information insert warns against using Cytotec to induce labor: Pfizer Patient Information: Cytotec Labor and delivery: Cytotec can induce or augment uterine contractions. Vaginal administration of Cytotec, outside of its approved indication, has been used as a cervical ripening agent, for the induction of labor and for treatment of serious postpartum hemorrhage in the presence of uterine atony. A major adverse effect of the obstetrical use of Cytotec is the hyperstimulation of the uterus which may progress to uterine tetany withmarked impairment of uteroplacental blood flow, uterine rupture (requiring surgical repair, hysterectomy, and/or salpingo-oophorectomy), or amniotic fluid embolism. Pelvic pain, retained placenta, severe genital bleeding, shock, fetal bradycardia, and fetal and maternal death have been reported. There may be an increased risk of uterine tachysystole, uterine rupture, meconium passage, meconium staining of amniotic fluid, and Cesarean delivery due to uterine hyperstimulation with the use of higher doses of Cytotec, including the manufactured 100 mcg tablet. The risk of uterine rupture increases with advancing gestational ages and with prior uterine surgery, including Cesarean delivery. Grand multiparity also appears to be a risk factor for uterine rupture. The effect of Cytotec on later growth, development, and functional maturation of the child when Cytotec is used for cervical ripening or induction of labor has not been established. Information on Cytotec's effect on the need for forceps delivery or other intervention is unknown. Excerpted from Pfizer's Patient Information Insert on the drug Cytotec. If your caregiver suggests inducing with Cytotec, ask questions to give you a better understanding of why they prefer this choice and what your risks are. Be sure to understand all of the potential risks and benefits before making your final decision. The Risks of Inducing Before 39 Weeks Gestation | |
 Pregnancy lasts about 40-weeks, according to the American College of Obstetricians and Gynecologists (ACOG). But many pregnant women are given the choice of inducing labor before then, some of them before the end of the 37th week, which is considered preterm. Those early babies, delivered after an elective induction or cesarean, are contributing to the nation's increasing preterm birth rate which was over 12% in 2007 (the latest year for which figures are available). According to the March of Dimes babies born prematurely can have serious, lifelong mental and physical challenges. The March of Dimes has begun a campaign to ask the medical community to stop the practice of electively inducing labors before 37 weeks.The American College of Obstetricians and Gynecologists has responded: ACOG now recommends that "elective deliveries not be performed before 39 weeks gestation to minimize prematurity-related neonatal complications." In a study done with a group of Utah hospitals, physicians were able to reduce the number of babies born before 39 weeks from 28% of all elective deliveries to less than 3% of all elective deliveries. You can read the study in its entirety by clicking here. Read on to find out whether you are good candidate for a medically-induced labor. What is the Bishop Score? The Bishop Score is a rating on a scale of 0 to 13 that can help determine how effective a labor induction would be for any particular pregnant woman. Scores of 5 or less would indicate that the woman had an "unfavorable cervix," meaning that her body is not yet preparing for labor and that she would not be a good candidate for a labor induction. On the other hand, higher scores indicate that the woman's cervix is beginning to soften, thin (efface) and perhaps even open (dilate), and that she would likely respond readily to an induction. According to a study done by the Intermountain Health Care Agency (IHCA), which runs a group of hospitals in Utah, the lower the number on the Bishop Score, the higher the chances of a woman's induced labor ending in a cesarean birth. The chart in IHCA's patient information pamphlet shows that women whose Bishop Score was 0, had an average labor of more than 19 hours, and had a cesarean birth more than 37% of the time. In contrast, the chart shows that women whose Bishop Scores were 13 had shorter labors, averaging six hours, with a 0% chance of a cesarean birth. What this means in practical terms is that if your caregiver suggests that your labor be induced, or if you are interested in having an elective induction, ask what your Bishop Score is. That will help you decide, based on what is happening naturally in your body, whether you would be a good candidate for either a medical or a natural labor induction. Read on for credible, up-to-date information about each. Inducing Labor With Drugs Chances are pretty good that you know a mom who had her labor induced with a drug. That's because every year, almost one quarter of all pregnant women in the United States have their labors artificially induced, which means they are given drugs to help the uterus to contract and/or the cervix to ripen. Drugs that are typically used to induce labor are:
Inducing Labor Without Drugs  While inducing labor with the drugs mentioned above are the most common methods used in hospitals, there are some non-medical ways to start labor that can be done at home, after getting permission from your caregiver that your baby is full-term and that starting labor isn't likely to pose any known risks to either you or your baby. Remember that inducing labor, with or without drugs, is still calling your baby into the world before he or she may be ready. Be sure to understand all of the potential risks before following any method of labor induction. Common Non-Medical Ways to Induce Labor Sexual Intercourse: Semen contains prostaglandins which can help to soften or ripen the cervix to help prepare it for labor. Also, having an orgasm produces oxytocin which is the hormone that makes the uterus contract. There are no statistics on how effective intercourse is, but it could certainly be a nice way to spend time with your partner while waiting for labor to begin! Only try this if your water is still intact. Herbs: There are several herbs that have been known to start labor, but some herbs can be harmful in pregnancy so be sure to check with a credible source before choosing an herb to induce labor. Always check with your caregiver first. Acupressure: Several acupressure points on the body can help to stimulate labor. This website, written by a New Zealand acupuncturist, describes them and includes illustrations and video. Amniotomy: This is the deliberate breaking of the amniotic sac by an obstetrician or midwife in an attempt to start labor. There are no studies that conclusively state that breaking the bag of waters either brings on labor or helps it to progress. There are two risks: one is the risk of uterine infection, and the second is the risk that labor won't start within a prescribed time (usually 12 to 24 hours) which can result in the mother being given Pitocin to induce labor. Sweeping the Membranes: This refers to a procedure where a physician or midwife inserts several fingers into the cervical opening and sweeps the fingers between the amniotic sac and the uterus to help stimulate the hormones that ripen and dilate the cervix. It can be quite uncomfortable for the mom, and can sometimes cause the bag of waters to break. (See Amniotomy) So there you have it – the three most commonly used drugs for labor induction plus a few non-medical methods. As you can see, even though "being induced" is pretty common these days, and a life-saving tool in some situations, it is not without some risks and downsides. If your caregiver wants to induce your labor, ask questions, read, and talk to friends who have been induced so you can make the right decision for you and your baby. | |
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