Induction of Labor: What is the RUSH?

Today Jaelin talks about the process of medical labor induction, inductions side effects and risks of labor induction drugs.

Points from the Midwife Monday Video:

We are going to review why you may or may not want an induction.  We are not giving you medical advice or telling you to induce or not to induce. This is just information that should be covered in informed consent.  This is a big subject, and we don’t have time in one sitting to cover this in depth, however, we will be going more in depth at our YOU CAN seminar on December 1st.

WHY does the medical society push inductions?

According to ACOG, if we induce all women at 39 weeks, we can prevent most stillbirths from happening. Go to Evidenced Based Birth and read their dating paper on rates of stillbirths. This might be true, but then we create other scenarios that cause different risks to mother and baby. So, what we do is trade one risk factor for another.

As midwives, we believe the body was meant to get pregnant, grow a baby, and birth vaginally.  It is a normal life cycle for a woman. Our bodies were created to do this to further advance the human race.  This is true of every species on the planet. We believe in physiologic birth.  We are happy there are alternatives when necessary and are thankful for OB’s who are surgeons and take care of high-risk situations.

What are the side effects of medications for induction? What is the normal course of induction?

Pitocin:  Side Effects- First and second stages of labor; slow infusion over 24 hours has caused water intoxication with seizure and coma or maternal death due to oxytocin’s antidiuretic effect.

Maternal: Coma, Seizures, hypotension, hypochloremia, hyponatremia, water intoxication. Increase uterine motility (too many contractions), painful contractions, abruptio placentae, decrease uterine blood flow, hypersensitivity

Fetal: Intracranial hemorrhage, asphyxia, hypoxia, arrythmias, hypochloremia, hyponatremia, water intoxication

https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/018261s031lbl.pdf

Cervadil:

Maternal: Amniotic Fluid Embolism, Uterine Rupture, uterine contractile abnormalities, warm feeling in vagina, back pain, headache, drowsiness, syncope (fainting episodes), coughing, shortness of breath, wheezing, low blood pressure, high blood pressure, diarrhea, nausea, vomiting, allergic reactions including Anaphylaxis, chills and fever.

https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/020411s023lbl.pdf

Cytotec:  Intended use of the prevention of gastric mucosal injury from NSAIDs; induction of labor and abortions. It is not intended to be used in labor or induction. This is a very dangerous drug.

Side Effects: May cause uterine rupture, abdominal pain, headache, diarrhea, constipation, nausea, vomiting, dyspepsia, flatulence, miscarriage, menstrual disorders

https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019268s041lbl.pdf

This link is an article from The Journal of Perinatal Education about a mother and baby who died after a cytotec induction and the Dr. telling the family it’s rare but can happen. No informed consent obtained and even though the mother knew it was off label, she was basically ignored and obviously didn’t understand she could say NO.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684033/

https://www.scienceandsensibility.org/p/bl/et/blogid=2&blogaid=139

https://www.ncbi.nlm.nih.gov/pubmed/17267868

What typically happens during an induction?

When you go in for an induction, you get your IV, blood work, a cervical exam, and the nurses should be evaluating your medical records the physician has sent over. If your cervix is not favorable (Bishop Score), then you will be given Cytotec or Cervadil for cervical ripening.  Cervadil is a little gentler and you should be able to eat and drink during this time. Typically, when you start the Pitocin, you will be told no eating or drinking, only ice chips.  You will be at the cervical ripening stage from 6-24 hours, this varies from physician to physician.

Then you will be started on the Pitocin, which will be increase every 20-30 minutes until you have contractions every 2-3 minutes. Then you are keeping our fingers crossed that labor progresses from here. Typically, your cervix will be checked every 2 hours, some places more often, some less often.  When the contractions get to every two minutes, they are pretty intense, and they are much worse than natural contractions. At this point, most women are requesting an epidural.

In order to get an epidural, they must give you a liter of fluid. Some anesthesiologists may want 2 liters prior. This is because the medications in the epidural causes low blood pressure. Low blood pressure causes less blood to the baby. This is not good.

So, in order to give you an epidural, they need to increase fluid volume to increase blood pressure to counter attack this issue.  Now if you remember, some of the side effects of Pitocin-its an antidiuretic (retain fluids). Now we have excess fluid for mom, and we have to listen to her lungs and ensure she doesn’t develop pneumonia. The baby now has excess fluid too, so the baby will weigh more at birth. Then, when the baby loses “too much” weight (from losing the excess water), they will ask you to supplement your baby with formula, and you may be feeling like you have failed your baby and discontinue breastfeeding.

Once you get the epidural, your labor is going to slow down, so they will increase Pitocin, and break your bag of water. Now, you are at increased risk for infection. They will then check you more often and will possibly put an internal monitor in you to monitor the baby. This can not only increase the risk of infection but can also break the umbilical cord and cause your baby to bleed out.

Now your contractions are even stronger from the added Pitocin and epidural, which slows blood flow to the baby and causes fetal distress. This is the cycle that leads many mothers to an emergency C-section.

All of these interventions disrupt the natural process and come with some major risks. We want you to be informed about these risks, because many mothers were never informed by their doctors about the risks of induction and the spiral of interventions they can cause. Whether you choose to be induced or not is up to you, not your doctor.