The following is the first in a three-part series on what you need to know about medical interventions during labor.
When it comes to medical interventions during labor, most first-time moms equate it with, “Do I or do I not want the drugs?” As tempting as it may seem to say (or scream),“YES!” not knowing the full scope of medical interventions or how they can affect labor can impact a mother’s birth experience and how she remembers it.
To prevent unwanted surprises, I always recommend that parents-to-be do their own evidence-based research and ask their medical care provider the necessary questions to help them provide informed consent or refusal if and when an intervention is suggested. But before running to your provider’s office, here is some background on common medical interventions, starting with inductions.
Even before parents get to their birthplace location, moms are being reminded of their ever-present clock. Based on their estimated due date — commonly known as 40 weeks from conception or the first day of your last menstrual cycle — some care providers may encourage induction methods. According to the Listening to Mothers III Survey, 4 in 10 U.S. women were provided a method of induction. If the moms, however, were low risk and having an otherwise healthy pregnancy, this recommendation would be considered an elective induction.
This is important to separate from medical indicated inductions (e.g., evidence of low amniotic fluids, preeclampsia, gestational diabetes, etc.), because in elective inductions, the prevailing thought has been that it doubles your chances of cesarean sections. While the jury is still out on whether or not that’s accurate, the risk of additional interventions, including additional induction methods, pain medications and/or an emergency cesarean, remain present.
So what are some common induction methods?
Membrane sweeping/stripping: This is typically done near the end of one’s pregnancy, when the cervix has slightly dilated. The procedure involves the provider inserting 1-2 fingers deep into the vagina to reach the cervix. Once reached, the provider makes a sweeping motion in an effort to separate the amniotic sac from the cervix. If separated, the body may start to produce the necessary oxytocin hormone to kick start labor.
Breaking of waters: This method doesn’t usually get implemented without partial dilation and together with other induction methods, assuming the mother hasn’t started contracting on her own. In either scenario, the procedure involves the provider inserting a small, crochet-looking instrument called an amnihook and creating a small tear in the amniotic sac. By doing so, the amniotic fluid should begin to leak out. If effective, the mother should begin to feel contractions and/or the baby move further into the pelvis. In some cases, if the mother was already experiencing contractions, the strength may substantially increase. For mothers who hadn’t yet begun contracting on their own, the provider may also recommend a cervix softening medication such as Cervidil or Pitocin before breaking the waters.
Foley Catheter: With a Foley catheter (or “balloon catheter”), a small tube is inserted into the cervix in an effort to induce dilation. A saline solution is inflated into the balloon and stays inside until the cervix dilates to three centimeters, at which point it falls out and, hopefully labor commences on its own from there. A 2013 study showed that of 109 women hospitalized and given this pre-induction method, there was a 4% delivery rate, 66.7% who had a vaginal birth. Also to note, ~30% of women didn’t require the use of Pitocin for their delivery.
Medication inductions can also be used, sometimes in conjunction with mechanical inductions or on their own.
Dinoprostone (Cervidil or Prepidil Gel): This hormone-like medication is either inserted intravaginally or gently squirted into the cervix in an effort to soften or ripen it. Once the cervix is ripe, labor may commence or require additional medications.
Misoprostol (Cytotec): Another hormone-like medication originally created for ulcer prevention while taking NSAIDs, Cytotec can also help ripen the cervix during pregnancy. As a labor induction, the medication can be taken orally or inserted vaginally at a lower dose.
Oxytocin (Pitocin): The medication most moms hear about, this synthetic version of oxytocin is traditionally given to bring about or strengthen contractions. It is provided through IV and, like many other medication and mechanical inductions, requires continuous fetal monitoring to ensure contractions are steady and not causing fetal distress. Some reasons why providers might encourage Pitocin include: slow to start labor; premature rupture of membranes (PROM) if around or after 37 weeks; and dilation stalling after many hours in labor. Suggesting Pitocin, however, is often explained as a way to avoid an emergency cesarean section. But a 2013 article in the Cochrane Review showed that inducing low-risk women with Pitocin does not reduce the outcome of C-sections and only reduced the length of labor by approximately two hours.
Naturally, both mechanical or medication induction methods can impact our labor in a variety of ways:
- Continuous fetal monitoring
- Continuous intravenous fluids administered
- Limited freedom of movement
- Regular blood pressure and pulse checks
- Failure to actually induce labor
- Irregular patterns or intense contractions
- Potential fetal or maternal distress
The impact to an expectant mom will undoubtedly vary depending on method, but it’s definitely worth discussing with your provider ahead of time to have a clear understanding if and when these methods may be needed; if they can be postponed or avoided; if there are any potential side effects to you or your baby; how it can impact your birth preferences later during labor; and if there are alternatives your provider would recommend.
Stay tuned for part two where we discuss pain relief and other medical interventions!
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