Friday, November 6, 2009

Thoughts on Inductions and Encouraging Labor

As you can probably tell from some of my recent posts (particularly my facebook friday one) I'm getting ancy for this kiddo to be born. Ironically I'm not even to my due date yet, but my body keeps giving signs of labor, and I'm past the date where I delivered Bear, so I'm feeling overcooked even if I'm not really. I confess this last week I've given some thought to inductions, and feel like I have some understanding for why women choose that route. (I confess I even had a dream wherein I got one of my crochet needles and broke my own water!!) I never felt this way with Bear, first because I was prepared to go past 40 weeks because I know that's common for first-time moms, but secondly because I didn't have ongoing prodromal labor as I have this time. When labor started with Bear, it started and it continued until he was born. This time has, obviously, been very different!
There are two types of "induction," but they're not really the same at all, so I prefer to think of them as "inductions" verses "encouragements." The former will stimulate labor forcefully, the latter will simply encourage it to move along if (and only if) it is ready to happen anyway.

Standard inductions include administering synthetic hormones (such as pitocin) via IV, or via vaginal suppository (such as cytotec, which by the way, commonly causes birth defects, uterine rupture, and maternal death--if you don't look at any other links in this post at least look at this third one here!).  Inductions of this sort are commonly done because the woman is "overdue," or because either the woman or her doctor had a schedule to keep and just wanted to get the baby out already. A friend of mine put together an excellent post on why "Overdue is NOT an Emergency" and she cites many references to back up that stance.

Dangers of Induction
In my opinion, one of the biggest problems with having an induction based on dating is that estimated due dates (EDDs) are just that--estimates--and are wrong at least as often as they are right. A woman who has anything other than a 28 day cycle (or who ovulates on any day other than day 14) will have an inaccurate EDD if she bases it on her last menstrual period--which is what most providers do.
Secondly, EDDs are based on average gestations, but some women gestate for 38 weeks and some gestate for 42, and there are differences from one child to the next as well as from one woman to the next. So even if you know that your dates are correct (because you know your date of ovulation) you still can't really know how long your baby needs.
Inductions do not always work--particularly if the mother's body was not showing signs of readiness (dilation and effacement) prior to the induction. As mentioned in the post I linked above, when first time moms with no dilation and no effacement are induced at 41wks (merely because of the date), they have about a 50% chance of ending up with a c-section for failure to progress. In other words, half of them will not go into labor in spite of the induction, so their babies will have to be delivered surgically.
Finally, there is evidence to support the idea that every week (even every day) that a baby spends in utero prepares him for life outside the womb. It is true that medical science has found ways to save the lives of babies born very very prematurely, but ask any of those premie's moms and they will tell you that they would have preferred that the babies be full-term. Just because the babies are able to live does not mean that it is in any way desireable for them to have been born so early! Babies who are even just a couple of weeks premature often have under-developed lungs, insufficient fat stores, eating problems, immature livers (leading to jaundice), and underdeveloped/undersized brains. But don't we also need to worry about the baby getting too big? Nope, we really don't.
I believe that inductions are terribly overused, and not nearly as appropriate (or as safe) as we are led to believe.

Encouragements are quite different from inductions, in that they will stimulate contractions, help ripen the cervix, or facilitate the baby's head engaging with the cervix, but they will not really force labor to start. I am comfortable with encouraging labor--particularly when the woman's body has already been giving signals that it's about ready.
Here is a short list of labor encouragements and how they work:
  1. Walking--being upright and in motion can encourage the baby to descend into the pelvis and engage his head with mama's cervix, thus stimulating dilation. Many women find that physical activity brings on contractions as well.  (Safety feature--if mama's body isn't ready for labor, the contractions will usually stop once she stops walking.)
  2. Doin' the Deed--yep, you got it, the same thing that got the baby in can encourage the baby to come out. This actually works in four ways: A--daddy's semen contains prostoglandins (the hormone that softens the cervix), B--if mama orgasms then those contractions can stimulate labor contractions, C--nipple stimulation releases oxytocin (which is explained more fully below), and D--getting mama relaxed and increasing her blood flow to her pelvic area can be helpful as well. There is really a lot more in common between getting babies in and getting babies out than what most of us have been told, but all the organs and muscles are the same, and many of the sensations are comparable, so it's only logical that they should work together so nicely.
  3. Nipple Stimulation--I've heard a few mothers say that nursing their toddler got labor up and rolling, or of course daddy can help out, or mama can do it herself with a breast pump (it does need to be a sucking type of motion). The reason it works is that it releases oxytocin, as mentioned above, and oxytocin causes uterine contracting--this is exactly why immediate breastfeeding helps to get the placenta out and reduces the risk of postpartum hemmorage (because it causes the uterus to clamp down).
  4. Consuming Castor Oil--basically castor oil will stimulate the bowels, and since the bowels and uterine muscles are ajacent, stimulating one often stimulates the other. (Loose bowels is a common symptom of early labor, as the body tries to get everything out of the way to make as much room as possible for the baby to get through.) Theoretically any laxative could cause this result, but obviously laxatives also carry the potential danger for dehydration, and castor oil is sufficiently nasty that I doubt the average mama would take enough of it to overdose! Incidentally, on top of castor oil being nasty, it doesn't always work, so you may be taking a dose of nasty for no reason...just something to keep in mind. ☺ (If you do want to try it, I'm told it can be chugged in a glass of orange juice to cover the taste, or try mixing it with some scrambled eggs (before frying them), and you'll get greasy eggs but they won't taste too bad.)
  5. Eating Spicy Foods--these can stimulate the digestive system, which may stimulate contractions. Of course, spicy foods may also stimulate heartburn, so attempt this at your own risk! I have heard that garlic may work this way too.
  6. Squatting--my midwife recommends spending time in a deep squat (like a yoga squat--lean against the front of a couch or hang on an exercise ball if you need some support). Essentially this position can help encourage the baby's head to engage with the cervix.
  7. Dance--get your hips moving in as wide a range as you can, especially in circles (like belly dancing or hula). The wide stance opens your pelvis, and the movement can encourage the baby to descend...sortof like a combination of the walking and squatting. Whether or not you utilize this to encourage labor, it is also a very helpful thing to do during labor.  (edited to add: this is what got this baby to engage and come out. After 2 1/2 weeks of solid "early labor" every night, but no progress, literally a day and a half of hip circles every 30-60 minutes got his head engaged and moved him right down. I did hip circles during almost every contraction in labor too, and he was out in less than 5 hours. Your mileage may vary of course, but I have become a BIG proponent of hip circles!)
  8. Evening Primrose Oil--this can be consumed in capsule form or applied to the cervix directly. Either way, many midwives advise it during the final month or so of pregnancy, and it is supposed to help soften the cervix, which in turn should facilitate dilation when labor does start.
  9. Acupuncture or acupressure--it's important to do this with someone who is trained specifically for it, but some women report rapid results. Of course some women also report that nothing happened.
  10. Chiropractic Adjustment, Massage, or Reflexology--some women say it works, some say it doesn't... rubbing the lower half of mamas calves (in the back) is supposed to get things going...
  11. Consuming Red Raspberry Leaf--RRL is a uterine toner, so consuming it throughout pregnancy is a good idea anyway. Consuming increased amounts of it in the final weeks will not generally stimulate contractions, but can help the uterus prepare to work effectively when labor does start.
  12. Consuming Blue & Black Cohosh--these herbs are commonly touted in the naturopathic world as a "natural induction" but they do carry risks. I am not comfortable with them myself at this point, but if you are inclined to try them make sure you read up on them first!
  13. Get busy doing something else. Really. Stop focusing on being not in labor, and go find something productive to do--once the baby comes you'll be too busy to do anything else for a while, so use your time now to clean the house, play with your other kids, spend time with your spouse, pamper yourself, or change the world. ☺
  14. This site also has a great list of suggestions (with additional links with additional info)

If any of my readers know of other methods (or references) that I have neglected here, please leave them in the comments and I'll edit them into the post!!


Christa said...

I actually downloaded my music yesterday for number 7.
Diana Ross and The Supreme's Number Ones. I actually downloaded the CD to listen to while I'm cleaning, it's the music my mom and her mom always had use listen to while we cleaned when I was little. It gets me really motivated and I told my mom today I wanted to listen to while I was in the early stages of labor to help me stay up and help the baby come down.

BethNoel said...

I love your post, it's so informative for momma's that might not have a lot of access to some alternatives to "traditional" birth plans. One caveat though, castor oil can be very effective in starting labor, however, it can also be detrimental to the baby for the same reason that it starts labor. The castor oil might cause the baby's bowels to be loose as well and, as I am sure you know, babies should never pass meconium in utero due to the risk of aspirating the meconium. Just thought I would pipe up about that one idea...all the others sound like great options! Good luck Jenni!

Christa said...

oh and thank you for what you said about inductions, I needed to hear that today, I have a friend who's sister was induced today because she asked to be, so the doctor said it looked like she had too much amniotic fluid, and then after less than 10 hours they rushed her in to do an emergency c-section. It just makes me mad that she put herself and more importantly her child out there like that. It's just disheartening to see someone choose their own comforts a few days early over their childs welfare.

~Aimee~ said...

Prodromal labor is so exhausting, physically and mentally. With my first, I had contractions all the time, for months, so it took awhile to believe I was really in labor. With my second, it was similar, but then I did go into real labor for 6+ hours, before it petered out around 9am. I spent the rest of the day, trying to get it going again, without much success. At 4:15am the next morning, it started again, but I slept through part of it. Then I woke up in transition and an hour later my son was born. I think all the prodromal labor helped the true, active labor go so quickly. But I commiserate with how frustrating and exhausting it can be!

SST Wellness Center said...

There is also a balloon catheter method that midwives have used (don't know if Doc's do?) where the balloon catheter is inserted and inflated, that stimulation can get things moving. When you are dialated past 3 it will come out. One note: I know of a case where the baby's head came down and trapped the catheter giving the false impression that the dialation process hadn't reached a 3, there for the mother suffered through the night because she kept being told she wasn't ready and to wait. By the time she went in to her early morning appointment she was at a 9 and they had to pop the balloon and the baby was born. Mother had some complications after. The midwife had never had that happen before and hadn't heard of it happening. So just be aware. She was in pretty hard labor 6 hours after the catheter was inserted. She should have been checked earlier. The baby would have been born much earlier. This was a first baby.

Kelly said...

Great post! I agree with you - induction is extremely over used and the risks are usually not even discussed with the mothers. :(

T said...

Good post.

Just one question though - how can Cytotec cause birth defects when it's used for induction? Isn't it rather late at that point for the baby to accumulate birth defects? From the website, it appears that that warning is about taking the drug while pregnant. I can't imagine exposing the baby to it for a few hours immediately prior to birth would cause anything that could be classified a s a "birth defect" - though it can certainly cause a lot of other problems!

Mommy Bee said...

I don't know that cytotec causes birth defects if used only for induction (though it does cause uterine rupture and has caused a frightening number of deaths), but the point is that it's contra-indicated for use at *any* time in pregnancy, and that should include labor...

Brandi (Maxfield) Morstad said...

very informative! I'll have to refer back to this when the time comes for me :)

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