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 womans due date.
The most common way for
a woman to be induced is to begin her labor with
pitocin. Pitocin is an artificial form of the bodys
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.
pitocin stimulation in labor include, but are not
- ß Fetopelvic Disproportion
- ß Fetal Distress
- ß Placenta Previa
- ß Prior Classical Incision or Uterine
- 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.
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 womans 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
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
- ß To place the internal fetal monitor on the
Amniotomy has several
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
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.
- ß This is the only cushion your baby's head
- ß The increased pressure differentials
around the fetal head may lead to
When used properly, the
advantages can outweigh the disadvantages.
(approximately 7 cms),
- 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
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.
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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