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Methods of Induction

(The following is a compilation of information from various books, website and personal information)

 

     There are many methods used today to start the onset of labor when it, for some reason, does not start on its own. There are also pros and cons to using them. These same methods can also be used to augment labor once it has begun, and to stimulate labor to begin even before a woman’s due date.

Pitocin

     The most common way for a woman to be induced is to begin her labor with pitocin. Pitocin is an artificial form of the body’s own hormone, oxytocin. Pitocin is supposed to be used to induce labor or increase the strength or duration of contractions for the health of mother or baby. In practice, it seems that pitocin is used much more frequently, even when it's usefulness and safety are still questioned.

     Oxytocin, the body's natural hormone, is secreted in bursts. However, when you are given pitocin you are placed on a regulated intravenous pump, to regulate the amount of pitocin to a steady flow. Therefore, pitocin induced contractions are different from your body's natural contractions, in strength and effect. With pitocin, the induced force of the contraction may decrease uterine blood flow (This is also done during a natural contraction, but not for as long of a period and not as close together.). Therefore, reducing the oxygen to the baby. With pitocin you will also receive continuous electronic fetal monitoring. This is because fetal distress is more common with pitocin use and needs to be detected if it occurs.

     Pitocin can also be the beginning of a domino effect of interventions. The IV, the infusion pump, and the continuous monitoring will confine most mothers to bed, decreasing her ability to deal with the contractions naturally. With the more painful contractions, a mother is more likely to need pain medication, such as epidural anesthesia. Pitocin can present other hazards. For the mother these include: tumultuous labor and tetanic contractions, which may cause premature separation of the placenta, rupture of the uterus, laceration of the cervix or postbirth hemorrhage. Fetal hazards include: fetal asphyxia and neonatal hypoxia from too frequent and prolonged uterine contractions, physical injury and prematurity if the due date is not accurate.

     Contraindications to pitocin stimulation in labor include, but are not limited to:

  • ß Fetopelvic Disproportion
  • ß Fetal Distress
  • ß Placenta Previa
  • ß Prior Classical Incision or Uterine Surgery
  • ß Active Genital Herpes Infections

     About 80% of women who have had pitocin say that there is more pain with pitocin than without. Unlike natural contractions, you do not get the slow build up, rather the contractions may began at a harder and faster rate than most normal natural labors. Most women surveyed say stated that they would rather try alternatives to pitocin with their next labor.

     "It was nothing like the gradual up and down they described in childbirth class. If you have to have labor induced with pitocin, imagine the worse as far as contractions. I had hoped to avoid an epidural but I believe that because of the pitocin, I had to have the epidural. I will try without next time as long as I don't need the pitocin." - Tracy "The contractions on the pitocin were so intense and so completely different than the normal contractions. They were harsh, sudden and agonizing. I felt like I was utterly out of control and could not stand it." - Gena

 

     Pitocin helps in about 5% of the cases, but only after safer alternatives have been tried and failed. Proponents of pitocin say that it helps only if given to the mother before she and her uterus are exhausted. There is a critical window of opportunity during labor that pitocin will help get labor back on track. Once this has been missed, they believe that a cesarean is basically the only solution. When inducing labor with pitocin, it works best when the uterus is ready to receive it. Giving pitocin before the uterus is ready or ripe enough to receive it is likely to produce a long, drawn out and many times unsuccessful labor. There are natural and medical ways of ripening a cervix, both having to do with prostaglandins.

     Use of pitocin after birth is not necessary on a routine basis, despite that it is a common procedure. Giving pitocin after birth is quite common. It is said to be used to get the third stage (expulsion of the placenta) over with quickly and prevent postpartum hemorrhage. Nature will help your body provide oxytocin on it's own if stimulated by nipple stimulation and massaging the uterus. There are times when there is no time for nipple stimulation, but this is rare. However, medical technology is useful when not used inappropriately.

Prostoglandins

     Other types of synthetic induction agents being used more commonly are: cytotek, misoprostal and prostoglandin gel. These are all synthetic forms of prostoglandins, which are found naturally in a pregnant woman and in semen. These are used in two ways: to ripen a cervix that is unfavorable, and to induce labor. The procedure is to put the gel or tablet on the woman’s cervix, or to take the tablet orally. It is less invasive than using pitocin, as it can be done without the use of IVs. However, it can have side effects.

     The most common problems are: uncontrollable and rapid contractions, may not induce labor, not approved by the FDA, overstimulation of the uterus, nausea, vomiting, diarrhea and shivering. It can also have an affect on blood pressure. Side effects are influenced by the dosage and placement of the drug.

Amniotomy – Artificial rupture of membranes

     Amniotomy is another technique used frequently to induce or augment labor. It is the artificial rupture of the amniotic sac with a tool called the amniohook (a long crochet type hook, with a pricked end) or an amnicot (a glove with a small pricked end on one finger). One of these will be placed inside the vagina, where the caregiver will rupture the amniotic sac or membrane.

     Amniotomy is said to be done for three reasons:

  • ß To induce or augment labor.
  • ß To check for meconium (baby's first stool).
  • ß To place the internal fetal monitor on the baby's scalp.

     Amniotomy has several disadvantages.

  • ß This is the only cushion your baby's head has.
  • ß The increased pressure differentials around the fetal head may lead to deformities of the skull
  • ß The reduction in the amount of amniotic fluid may increase compression of the umbilical cord which would show as fetal distress during labor.
  • ß This increases the possibility of a cord prolapse.
  • ß This increases the likelihood of infection (from vaginal exams and probes placed into the vagina)
  • ß Most practitioners will start the cesarean clock once the amniotomy is performed.
  • ß This may cause your practitioner to restrict you to bed.
  • ß This may cause your practitioner to restrict your use of the tub or bath.

     When used properly, the advantages can outweigh the disadvantages.

  • ß It enables the condition of amniotic fluid to be viewed
  • ß It can possibly, if done late in labor, such as a stalled late first stage (approximately 7 cms), speed dilatation

Natural induction methods

     Lastly, and maybe most importantly, there are many natural ways to induce and augment labor, without the use of artificial drugs. Sex and nipple stimulation can be very effective in starting and augmenting labor. Semen has prostoglandins in it, so using sex to get prostoglandins on the cervix can soften it and make labor start. Nipple stimulation releases oxytocin which stimulates contractions and can also make them more productive. This can be done manually, with the help of a partner suckling or with a breast pump.

     Walking and changing positions are completely non-invasive methods of starting and augmenting labor.

      Another way is to strip the membranes. Stripping membranes involves the health care provider inserting her finger into the cervix and separating the cervix and lower uterine segment from the membranes. It can generate local production of prostaglandins and frequently brings on labor in someone who is near to beginning labor. There is a chance that the water may break and it may be a little painful to some. If it works, it usually causes labor within three days.

     Other forms of natural induction include the use of herbs. Black and blue cohosh both tone the uterus and can stimulate contractions. They can be used to start or augment labor. They are taken orally either as a liquid or capsule. Drawbacks include false labor, uncomfortable toning contractions, and may also cause a drop in blood pressure. Borage and flax seed oil, black current oil or evening primrose oil, 3-6 capsules, taken orally, every day and/or rubbed directly on the cervix if bag of waters is intact, after 37 weeks, can soften the cervix, tone the uterus and stimulate contractions.

     Castor oil and enemas both stimulate the bowels and, in turn, may cause uterine contractions leading to labor. The drawbacks are that they may not start labor, only diarrhea and cramping. If this happens and causes labor, the woman may experience more pain.

     Acupuncture and acupressure can also be used to start labor. There are places near the ankle and on the inside of the mouth that can stimulate uterine contractions.



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