Why do so many birth workers agree that medical induction is a bad choice? There are many reasons, which I will get to, but first let me say that a medically necessary induction is a completely different world to an elective induction. A medically necessary induction is usually performed because there is a threat to mother or baby; or both.
Elective induction however interferes with a perfectly healthy pregnancy, which puts at risk both mother and baby. Far too many times we hear that mum has to be induced because of a big baby, only to deliver an average sized baby. Mum has gone over her “due date” and that’s dangerous or some such nonsense.
Don’t Induce For Dates
There have been recent studies showing that some babies need only 37 weeks gestation, and others up to 44 weeks gestation. Unless there is actual signs of fetal distress, or mum’s health is poorly, there is no medical reason to induce for dates. Because the actual date of conception can never be known, even if we know the day we ovulated, even if we know the time of intercourse, there is a window of 5 days for a healthy ova’s lifespan and there is a window of sperm survival of up to 3 days. So we can never say at exactly which day that particular ovum is fertilised, so how can we exactly predict an expect due date? We Can’t.
Don’t Induce For Size
As for inducing due to guestimated large baby, this isn’t enough evidence to risk baby and mum. Many, many women of all shapes and sizes deliver large babies, some of them whoppers! Lets not forget that throughout pregnancy the hormone relaxin does it’s job by relaxing the muscles and tendons surrounding the pelvis, giving the birth canal a larger surface area. The sacrum or tailbone is mobile, and moves during delivery, again giving even more surface area to the birth canal. Women’s bodies were designed to birth, so we really need to let them.
The Risk Of Induction
With a standard induction, it usually begins with a hormone pessary, or gel placed next to the cervix to soften it and open it up enough for membranes to be ruptured. With both the pessary and the gel, there is a risk of the uterus becoming hyper – stimulated, where the uterus will contract continuously. Contractions start, end and have a break between. This is natures way of drawing blood toward the uterus to contract, then pushing it back to the baby, so the baby doesn’t suffer from oxygen deprivation. If there are continuous contractions, there is extremely limited blood flow going to baby, and so a very great risk of brain damage.
Once the cervix has opened enough, about 1 -2 cm, the membranes will be ruptured. This is because a flood of hormones is released when the membranes rupture, and can cause labour to start. Sometimes it works, mostly it doesn’t. And once those membranes are ruptured, there is a ticking clock, you must have delivered your baby within 24 hours.
Then a synthetic form of oxytocin is placed on a drip and pumped into you (called syntocin). Syntocin produces extremely strong contractions that give the mother no chance to build up to, like natural labour does. The contractions are longer and stronger, which again takes blood flow away from the baby for periods of time that are far too long. This is typically when the baby registers as in distress, then more harsher interventions are taken.
A Snowball Effect
When the mother has no chance to work her way up to the strong contractions, her natural birth plan goes out the window because she’s in far too much pain, typically she will first ask for narcotic pain relief, then local pain relief (epidural). Even though mum is having intense, painful contractions, that doesn’t mean that the induction is working, she may not be dilating at all. Or dilating so slowly, that that ticking clock is forcing the medical team to increase the rate of syntocin delivery. Mum can’t move around freely because of constant monitoring or epidural to help baby’s descent.
When the rate of syntocin is turned up higher and higher there is an almost certain chance that baby will show signs of distress. With mum confined to bed, on her back, with an epidural, it is much harder work pushing baby uphill, rather than working with gravity to help baby out. Lying on the back has proven that the surface area of the birth canal is drastically reduced. If mum has dilated, then an episiotomy is performed and either forceps or ventuse extraction are used to get baby out in a hurry.More often than not, baby shows signs of distress, so an emergency c section is performed. This is what we call a snowball effect, once one intervention is performed, another, then another, then another. Which puts baby at risk, mum at risk, and usually ends up with mum very unsatisfied with her birth experience.
This is why we; birth workers don’t like to see inductions performed electively, we know the very high risks, and we know of the snowball effect of interventions.
Of course, as doula’s we support every single one of your choices, yet as doula’s we will not let you make an uniformed choice, we give you the information, you make the choice, we support it.