Induction

In some situations, a woman and her doctor may decide to induce her labor, instead of allowing it to start naturally. According to the National Center for Health Statistics, approximately 20 percent of labors are started artificially, and that percentage is increasing every year. Labor may be induced for medical reasons if the mother's or baby's health is at risk, while elective inductions are performed for non-medical reasons such as convenience or the mother's comfort. There are risks associated with both necessary and elective inductions and you should learn all the facts and discuss the procedure with your doctor before deciding to induce your labor.

Your labor may be induced for medical reasons when:

• The risks of continuing the pregnancy are greater than the risks of delivering the baby right away.

• The baby is two weeks past an accurate due date.

• Your bag of waters breaks but labor doesn't start on its own within a reasonable amount of time.

• You have previously had a full-term stillbirth.

• The baby isn't thriving or growing in the uterus.

• Tests indicate that the placenta is no longer functioning at its best and the uterus is no longer a healthy environment for your baby.

• You have a chronic or acute illness such as high blood pressure, kidney disease, preeclampsia, or diabetes that threatens your health or the health of your baby.

Labor may be induced using natural and synthetic methods. The method your doctor uses to induce labor will depend on the condition of your cervix at the time. If your cervix has not started to soften, efface, or dilate, your doctor will use hormones or other methods to ripen your cervix before inducing. Some of the most common methods are:

• Artificially rupturing the membranes (bag of waters). This method causes no more discomfort than a vaginal exam and is usually very effective. Synthetic oxytocin (Pitocin) is often given to help when your membranes are ruptured artificially. However, labor may not begin for a long time, or not at all with this method. Rupturing the membranes can cause fetal distress and increase the likelihood of a cesarean section delivery, and it may also cause umbilical cord prolapse.

• Stripping the membranes. In this method, the doctor separates your bag of waters from your cervix to stimulate prostaglandin release and promote cervical ripening. This procedure has been shown to be effective in stimulating labor. It is not intended to break your water; however, it may. It may also cause infection and may be painful.

• Inserting a prostaglandin gel or suppository into the vagina to ripen the cervix. This procedure alone will often begin labor; however it may also require the use of Pitocin, a synthetic form of oxytocin. Risks associated with this method include fever, diarrhea, possible hemorrhaging after birth, and fetal distress.

• Using Pitocin, a synthetic form of oxytocin, intravenously in controlled amounts. Risks associated with this drug include an increased possibility of uterine rupture, increased likelihood of a fetal malpresentation or malposition, as well as an increased need for c-section delivery.

• Nipple stimulation releases the body's own natural oxytocin. Some studies have found it to be effective in starting labor within 72 hours if your cervix is already ripe, but the method has not been well studied. You should not try this method at home because it can cause prolonged contractions that could stress your baby and depress his or her heart rate.

• Walking naturally releases oxytocin.

• Castor oil is a strong laxative and stimulating your bowels may cause some uterine contractions. However, studies have not shown it to be consistently effective and the resulting cramping and diarrhea may be an unpleasant way to begin your labor. There is also an increased risk of fetal distress and there have been cases when the castor oil causes the baby to pass meconium before birth.

• Insertion of a Foley catheter into the cervix. The catheter has a very small balloon at the end of it which, when inflated with water, puts pressure on your cervix. This stimulates the release of prostaglandins, which then cause your cervix to open and soften. When your cervix begins to dilate, the balloon falls out and the catheter is removed.

• Accupressure may help to induce labor. Some pressure points include the roof of your mouth, the webbing between your pointer finger and thumb, and about four fingerspaces above your ankle.

• Herbs such as blue and black cohosh, goldenseal, squaw vine, red raspberry leaf have been used, mainly by midwives, for inducing labor. However, herbs vary in concentration, and their safety and effectiveness have not been proven. There have been cases of uterine rupture and intrauterine fetal stroke, as well as neonatal heart irregularities associated with the use of herbs to induce labor.

Elective inductions, or those that are performed for non-medical reasons, have become one of the most frequently performed medical procedures for women in the United States. However, the American College of Obstetricians and Gynecologists and the American College of Nurse Midwives discourage elective inductions, as do virtually all textbooks and most research. Studies support the use of medications to begin labor only in situations where continuing the pregnancy presents a clear health risk to either mother or baby. In addition, a recent study conducted by Dr. Barbara P. Yawn and colleagues from the Mayo Clinic and the Olmstead Medical Center in Rochester, Minnesota concluded that induction increases the risk to both the mother and infant.

Attempts to induce labor don't always succeed; many fail and the mother must then undergo a c-section delivery. C-sections performed after a failed induction are associated with higher rates of complications, infection, and longer hospital stays. Induced labors have higher rates of fetal distress and more often require the use of forceps, stricter bed rest, restriction of food and fluids, and more frequent monitoring of the baby's and mother's vital signs. Labors are often longer and women get epidural anesthesia more frequently, suggesting that induced labors are more painful.

Under certain circumstances, a woman should not attempt to have her labor induced and instead should deliver by c-section. You should not have your labor induced if:

• Tests indicate the baby is in distress or can't tolerate contractions.

• You have placenta previa.

• The baby is in a breech position.

• You have had more than two c-sections or certain other kinds of uterine surgery, such as a myomectomy to remove fibroids.

• You are carrying triplets or more.

• You have an active genital herpes infection.

• You have a cord prolapse. This is when a loop of the umbilical cord has poked through the cervix. During labor, the cord could become compressed and the baby's oxygen supply cut off.

Labor induction is a controversial procedure and you should learn all the facts, discuss it with your doctor, and weigh the risks and benefits before deciding to induce labor.