Thursday, March 26, 2015

Induction of Labor - Make an Informed Decision

The Association of Women's Health, Obstetric and Neonatal Nurses, (AWHONN) is currently running a campaign to educate and promote a full 40 weeks of pregnancy to allow all babies to grow and develop completely before delivery.

If induction is chosen or necessary here are a few things you should know.

MEDICAL INDUCTION OF LABOR:  A medical induction is one that is determined by your provider.  If they believe that delivery provides more health benefits for mom, baby or both than remaining pregnant would, a medical induction is scheduled.  Medical indications to induce before 39 weeks are determined by ACOG (American Congress of Obstetricians and Gynecologists). 

ELECTIVE INDUCTION OF LABOR:  There are times when induction is scheduled for life circumstances or convenience not dictated by medical necessity.  These are personal preferences and are a commonly accepted practice in the United States.  There are times when a planned delivery is much less stressful to patients, their families, as well as their providers.  These are elective procedures.  Elective inductions can only be scheduled after 39 weeks of pregnancy (within 1 week of the due date).  They are most effective when the cervix is ready and has already started to thin and dilate on its own.

  • Elective inductions are scheduled on a first come first serve basis by providers.  

  • We recognize the anxiety and excitement of each delivery, and the importance to some that a specific date or schedule be honored.  Please be aware that if an unexpected number of patients come in laboring on their own, or need medical attention, elective inductions can be delayed or even re-scheduled to keep all of our patients safe as they labor and deliver in our care.

Induction of labor does come with risks.  Among those are increased risk of cesarean section, increased risk of an NICU stay if the lungs are not quite mature at delivery.  Over stimulating the uterus with medication to induce labor can lead to major complications for both mom and baby, and must be carefully managed by trained professionals.

For this reason we caution you against home remedies to induce labor.  Careful management of how baby tolerates contractions is critical for both mother and baby's well-being.

Labor may be induced utilizing a variety of methods.  You may wish to discuss the best option for your situation with your provider.

Catheter Induction:  A catheter, or tube, may be inserted into the uterus through the cervix and a balloon inflated.  Some providers choose to inflate an internal uterine balloon while some choose to also inflate a 2nd balloon on the outside of the cervix.  Either procedure increases pressure on the cervix and thins and dilates the cervix slowly without the use of medication.

Cervical Ripening Medication:  Multiple options are available to soften or ripen the cervix.  They may come in gel or pill form.  Cervical ripening medication can be a slow process but it also can cause full labor to kick in so attentive monitoring and assessment are needed during the initial phase after medication is given.

AROM:  Artificial Rupture of Membranes is a procedure in which your provider breaks the bag of water around your baby during a routine cervical exam.  This may be done by use of an Amnihook,

or an Amnicot.
The choice is usually based on physician preference and patient dilation.  Occasionally this may be all it takes to induce labor, but often is in addition to another type of labor induction method, typically Pitocin.

Pitocin Induction is the most common medication used to induce labor.  Pitocin is a uterine stimulant which mimics the natural occurring hormone Oxytocin.  There are risks, benefits and side effects to any medication given.  
  • Risks:  Pitocin causes uterine contractions and if not managed effectively can over stimulate the uterus affecting blood flow to the placenta and causing harm to the baby.  For this reason continuous monitoring must be used while using Pitocin to induce or augment labor.
  • Benefits:  Pitocin causes uterine contractions.  Therefore it will eventually bring about delivery.
  • Side Effects:  Pitocin causes uterine contractions which are painful.  Other side effects are extremely rare but can include shortness of breath, dizziness, headache, increased heart rate, and others.

In the end, it does not seem to matter to most women how labor started or progressed. Once that baby is in their arms, at that moment, all is right in the world.

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