The Truth About Induction

Photo @monetnicolebirths

Photo @monetnicolebirths

My friend, and former collaborative and consulting OB, Melissa Wolf is our resident OB today. She always reaches out to me when there is some horror story in the news that results in a lawsuit, because malpractice suits for maternity care providers are the real deal and they can ruin a careers worth full of work, dedication and passion.

She asks me, like our OB last week, what she can do to be a better doctor to her patients. Emotionally and energetically.

So, we've been talking a lot about birth trauma lately and both acknowledge what a tricky conversation this is...so, this week let's talk about induction.

People are extremely confused about the topic of induction. We are not sure where the confusion comes from, but I can lean to believe it is because a clear explanation needs to be given to women when induction is necessary and indicated.

For instance, many women who are induced for a medical reason maybe didn't receive a clear explanation as to why they were being induced or didn't understand the indication. Then, if they have an unwanted labor and birth experience, post-birth there can be a lot of feels.

Feels that need acknowledgement to move forward thoughtfully and holistically.

But today, we're educating because we can blaze through some of the confusion by giving you a clear, direct explanation. It is what we do best around here.

Today's post is real brass tacks. And now, we want to hear from you.

What was your experience like with induction? Did you feel supported in your quest to understand induction during your pregnancy, or not? Tell us your experience in the comments below.

Without further ado...thoughts from Melissa.

x,
R


Outside of western medicine, the concept of labor induction is shrouded in mystery. Myths abound as to why it’s recommended, how labor is started, and what effects induction has on the actual process of labor and childbirth. In the medical community; however, the process is fairly clear and the guidelines surrounding its use are well established.

Here’s the skinny: there are two categories of labor induction, elective and medical.

Elective induction means a woman has her labor started artificially because she requests to have this done. In elective cases, there is no medical reason for the induction; the patient simply wants to plan the birth of her child. Women commonly elect to have their labor started for logistical reasons such as child care arrangements, or for visiting family.

In order to have an elective induction, a patient must meet all of the following criteria:

  1. Be at least 39 weeks pregnant
  2. Have a “favorable” cervix, meaning a cervix that is soft and open, not firm and closed.
  3. Have a “proven pelvis” meaning she has delivered a baby of similar size through her vagina in the past.

A woman who meets the above criteria has no higher risk of cesarean section with induction than if she went into labor on her own.

Medical induction means a woman has her labor started artificially for a specific medical reason. These are advised by a health care professional because it is safer for the baby to be outside the womb, or, continuing to be pregnant is dangerous to the health of the mother.

Common reasons for medical induction are:

  1. The mother has diabetes of pregnancy or high blood pressure.
  2. The mother’s water breaks and true labor does not start on its own within 6 hours. If labor is not started, the baby can develop a serious infection requiring IV antibiotics in a hospital instead of snuggling up with mom, or, the mother may develop a serious uterus infection causing ineffective contractions and requiring cesarean delivery.
  3. The amniotic fluid is too low or the baby has stopped growing.
  4. The pregnancy is more than a week overdue.

If labor is not initiated in the above circumstances, the risk is fetal death which is obviously very serious and unwanted. Medical inductions can be started at any number of pregnancy weeks depending on the situation and do carry a higher chance of cesarean delivery.

Labor induction is typically done by giving oxytocin (the same substance a woman’s own body produces to start labor naturally) through an IV, or using a prostaglandin gel or tablet placed directly in the vagina next to the cervix. Some women are very sensitive to these medications and begin to contract painfully right away while other women need a much higher dose before they feel anything.

It is not possible to reliably start labor on your own at home by having sex, eating spicy food, walking, or driving on a bumpy road. If these strategies could routinely start labor, all women would be advised to avoid sex, walking, spicy foods, and bumpy roads throughout their pregnancies so as not to create premature births! Drinking Castor oil will give a woman diarrhea and sometimes contractions; however, it does not reliably create true labor either.

Labor inductions can be more painful and intense than natural labor and some women prefer to have an epidural for pain relief in these circumstances. Ultimately labor induction is something that each woman must individually discuss with her provider relative to her specific pregnancy.

Melissa Wolf is a witty, dry-sense-of-humored board-certified OBGYN and Holistic Health Coach who lives and works in Bozeman, Montana. She is also a professional speaker who entertains national audiences with presentations such as “Unwind Your Mind: Live Inspired,” “Boredom in the Bedroom: There Is No Female Viagra,” and “Menopause: Puberty in Reverse”. She spends time volunteering for Doctors Without Borders to expand her perspective and skills with global women's healthcare.