How can you induce a woman to go into labor, and why would a doctor induce someone instead of just letting them give birth whenever it happens naturally?
In: Biology
There was a large study called ARRIVAL and if showed that the risk to mom and baby after week 39 begins to increase. The risks include chance of preeclampsia and gestational diabetes developing and increase chance of c-section which has its own risk.
There are different ways to induce and it will depend on the bishop score. A bishop score looks at effacement (how thin the cervix is) dilation, if the cervix is back, middle or front, if cervix is hard, med or soft, and the baby’s station.
If the bishop score is 7 or below then the cervix needs to be ripened first otherwise the induction medicine will not work.
There are a few ways to ripening the cervix. There is prostaglandins hormone which can be oral or a vaginal insert. Prostaglandins is used to soften the cervix by the body. Prostaglandins also used for blood pressure and it is also produced during menstruation and causes contractions/cramps.
There is also the Foley ball which you need to be dilated a bit to do. The Foley is a catheter that is inserted in the cervix and blown up like a balloon. Then it puts pressure on the cervix similar to what the baby’s head will do.
There are membrane sweeps which can be done in doctors office. You need be dilated enough for doctor to fit a finger in. Then they separate the sac with the uterus. If you have a bishop score 6 or over this can increase chance of spontaneous labor but 5 or below it will not have effect more than someone who didn’t get it. A sweep may make water break so it’s not free from risk but it’s pretty low. Plus this way you will spontaneously go into labor which means baby won’t need to be on the monitor while you are in labor so you can move around more and even walk halls or take a shower etc.
If you are ripened you may go into labor on your own after cervix is soft but you may not so then pitocin will be introduced. Pitocin is a man made version of oxytocin which body produces to cause contractions it is used during active labor. It is also used in breastfeeding to cause the milk to be let down and at the same time that will cause contractions in the uterus which helps the uterus shrink to normal size. There is an open wound in uterus after birthing the placenta so the contractions also help with the healing of that.
Generally they will start pitocin on a small dose then raise the dose after a set time like every 30-60 minutes. For me they only go from 1-20 but they used to give even higher doses.
If body isn’t responding to the pitocin then they may break the waters.
In the end a c-section may be needed if labor doesn’t progress and baby or mom get stressed.
Now I will say that I went in 3 times for out patient ripenings over a week so I had 2 of the inserts which takes 12 hours each time and 8 of the pills which you get every 8 hours. During all of that my cervix went from no 50% effaced and not dilated to half a cm and 70% effaced. I would go home after each session hoping to go into spontaneous labor. Even with the best knowledge we have we don’t really know what triggers labor and birth so if a person’s body isn’t ready even the best medicine will not result in labor
At 41 weeks I went in to be fully induced. I had to start with the inserts again. About 8 hours in my water broke. When they went to take out the insert 4 hours later it was missing. It may have been dislodged when water broke but it could have been gone even later. Even with water being broken and the insert I had to wait several more hours before they started pitocin as I wasn’t ripe enough yet.
When I was on pitocin I stayed at 5 cm dilated for 8 hours so they inserted a catheter to measure the power of the contractions and determined they weren’t strong enough so they moved the pitocin to 20 (luckily was already on an epidural at that point). Then after another 6 hours or so I was 9.5 cm dilated so they actually moved the little part that wouldn’t finish dilating around the baby’s head so that I could be ready to push. In the end the baby got wedged in and I needed a c-section.
What’s more because the baby was 41 weeks she had pooped in utero so she ended up being in the NICU for 2 weeks. Which is anecdotal but supports the idea that late term increases the risk to baby. Babies are more likely to poop after 40 weeks because their bodies are ready. So she could have been “breathing” in the poop for a few days. It feels very strange to have a healthy pregnancy and a late term baby and spend time in the NICU.
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