On inductions...

... I hate them!

As an OB nurse, I can honestly say they suck. (Although to be fair, as I was approaching 40 weeks with no signs of baby coming this last time around, I was starting to think inducing sounded good! :s !!)

Anyway, here is a link to a great tool, which can be very helpful when considering inductions. There is a scale many practitioners use, called a "Bishop Score"... unfortunately, even when using the scale, many doctors do not really pay attention to the end result or at the least explain how the score might affect the success of the induction.

http://www.childbirth.org/interactive/induction.html

Now for my soapbox... why do I hate inductions (for nonmedical necessity, that is... sometimes they really are justified)?? Oh, thanks for asking!! :D

* You can't force a baby to be born - or shouldn't, anyway. Women's bodies should be allowed to start labor spontaneously, to decrease the stress and risks for both mom and baby. There is an intimate communication between mom's body and the baby's... when baby is ready to be born, chemical signals are sent to mom's body giving the thumbs-up. On the same note, if mom's body is ready to kick into labor for some reason (infection, etc) of its own, chemical messengers cue the baby's body. This give-and-take mechanism allows baby to start clearing the lungs of fluid, practice breathing, and have extended rest periods to allow sufficient energy and nutrients are available for the rigors of labor (as well as the first days adjusting to extrauterine life). If a woman is induced - assuming her body wasn't about to go into labor shortly already - these signals are never sent, and baby can often end up 'shell shocked' at the surprise of birth. This can lead to...
- poor feeding
- difficulties maintaining ideal temperature (newborns are at risk of low body temperatures to begin with... when a newborn's body temperature drops too low, they start experiencing 'cold stress', which can in turn cause respiratory difficulties and a slew of other concerns if not corrected)
- higher risk of infection
- respiratory difficulties

* Inductions have been proven to cause more painful, stronger contractions, and often longer labors... and have increased risk of instrumental delivery (vacuum/forcep assisted vaginal deliveries, or cesarean section). When a woman starts laboring spontaneously, the hormone oxytocin is released in small bursts; there are natural ebbs and flows of the releases, allowing for gradual build-up of contractions and complete rest periods between contractions. When the synthetic form of oxytocin (Pitocin) is administered, it is controlled by the nurse manually upping the dosage via an IV pump. Instead of slowly rising waves of oxytocin, the pump generally doses the specified amount of pitocin all at once - causing the uterus to go from zero to sixty (in terms of intensity), and then back again. With pitocin, there are no natural, built-in rest periods every so often. And again, since nothing will force a baby to be born (save a c/s), the use of pitocin or other induction techniques can cause the mother (and often fetus) to be miserable for hours and hours with little progression. This can lead to a mother opting for analgesia, which may have not been her intention prior to the induction.

* Interventions lead to interventions, which lead to interventions, which lead to... (you get the point!) Sure, the idea of getting to choose your baby's birthday sounds great --- why not?? Many times the trade off of a little more intense labor for a more convenient birth sounds fine... and I can understand that completely! But... an induction isn't as simple as just going in, having the IV of pitocin hooked up, and then having the baby. At many hospitals, once the pitocin is begun, continuous monitoring is also initiated. This can mean being stuck in the bed completely from that moment until baby is delivered. As hard as it seems to get out of bed once those contractions hit (and again I remember this well!), it is a vital way to help baby descend and begin the process of entering the birth canal. In order to be born vaginally, babies need to do some pretty fancy footwork (so to speak), and maternal position changes greatly influence the ease of which this can happen. Rocking in a rocking chair, using a birthing ball, walking in the hallways, and showering all allow for different pelvic positions, encouraging the baby to do these manuevers. (see http://www.transitiontoparenthood.com/ttp/parented/pain/positions.htm for some suggestions on different labor positions) The use of gravity is huge in this, and in cervical dilation; it's difficult to use gravity while laying in bed, though.
An example of how interventions can snowball:

Induction with pitocin (increased ctx pain/intensity) ----> Epidural Analgesia (for increased pain) ----> Confined to Bed/Continuous fetal monitoring/close blood pressure monitoring ----> Indwelling catheter placed (epidural analgesia often makes it difficult to void) ----> Fetal malposition (possibly due to lack of maternal position changes) ----> Decreased pushing sensation (secondary to epidural) ----> Need for instrumental delivery and/or maternal manipulation (vacuum, forceps, episiotomy and/or c/s)

(and there are plenty of places where many other interventions and outcomes can kick in...)

* Lack of informed consent Many physicians either inadvertantly or intentionally "gloss over" the idea of induction, and fail to present the risks and benefits in clear language so that the mother and father can make an informed choice. There are wonderful doctors out there, but it is important to feel comfortable asking your doctor for the truth - would s/he agree to be induced this point? What are the best/worst case scenarios? What should you expect? Unfortunately studies are showing that c/s rates are highest during the week, daytime periods (around 4 p.m.). Some doctors will start induction attempts in the morning, and if nothing's happening by 3 p.m., convince mom (who is usually pretty exhausted by this point) that a c/s may just be what has to be done because for whatever reason baby just isn't coming this way. Baby is born, mom is done laboring (but only after major abdominal surgery), and doc is home for dinner - and might be able to count on the added convenience of the next baby being born by scheduled repeat c/s, instead of gambling on a labor and birth that could take place - gasp! - in the wee morning hours.

Ok, I think I'd better fall off of this soapbox now!! :P I've noticed that this thread has gone from fairly benign in the beginning, to downright judgemental and snarky at the end. So, enough on this subject (for today, anyway).

In conclusion, though, the honest truth that I see in practice is that induced labors really are harder and longer, and tend to leave babies that just don't do quite as well as spontaneously occuring labors. Like everything else in life (remember the bell curve?), most inductions will be so-so and not have horrid outcomes; some will be awful (like the mothers I've seen go to intensive care for blood transfusions following failed inductions and c/s, instead of holding their new babies immediately following birth) and some will be great. Most will just be in the middle somewhere, which is fine --- but it should be up to the mother to make an informed, educated decision to induce or not, based on the facts. (The same sentence can be modified with "inductions" being replaced by "spontaneous labors" or just plain "labors"; I have seen scary outcomes with spontaneously occuring labors as well... but not as many)

There's always good things, and bad things.... this is my life!