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Inducing Labor with Pitocin: Making the Choice

Week 39, and you haven’t had a good night’s sleep in a month. You’re running to the bathroom every 15 minutes and you probably feel more like a beached whale than a woman. Pregnancy has been exciting, but all good things must come to an end…including this! You’ve had enough and you want this baby out!

For many pregnant women entering their 40th week, induction is a seductive concept: whether they’re worried about not having their doctors around for the delivery, or fearful of delivering huge babies; whether they’re hoping to deliver their babies on a specific day, perhaps for sentimental reasons, or they’re just tired of being pregnant. An elective induction suggests control. Besides, it’s done all the time, it’s easy, and it’s virtually risk free, right? Well, that all depends on when and how your doctor performs the induction.

Pitocin

Pitocin and Syntocinon are commonly used brand names for the drug Oxytocin, a hormone found naturally in the pituitary gland used to help start or continue labor and sometimes to control bleeding after delivery. The drug, given intravenously, is also used to help a mother expel the placenta post delivery, to shrink the uterus post miscarriage, and to help get a mother’s milk flowing for breastfeeding.

An advantage of Pitocin is the ease with which it can be controlled as needed during delivery. Cervical-softening gels may also be used during inductions, but while this administration is easy, doctors may find it more challenging to remove or control the progression should they wish to stop the effects. The ease with which Pitocin can be controlled is why Dr. Gerard M. DiLeo, MD, a Louisiana-based obstetrician, often tells his patients that he aims to use the drug just to get their labors started. He then weans them off as soon as their bodies take over. Dr. Tracy Kritz, MD, a family practitioner in Los Angeles, agrees that when used properly and when medically necessary, Pitocin can be “really useful stuff.”

But what does “medically necessary” mean? Pauline Ratta, a certified nurse midwife with Massachusetts General Hospital in Boston, highlights three instances when inductions are necessary:

  • If a woman is approaching the 42-week mark and still has not delivered.
  • If labor needs to be augmented, i.e. a membrane has broken but contractions have not begun.
  • If an epidural has slowed down the labor process, which may happen on occasion, and induction will resume it.

Selective Inductions

Many induced deliveries are for personal reasons—often convenience—rather than medical ones. Some doctors offer inductions to their patients if the doctor may be unavailable when a patient goes into labor. “You have the right to decide how your baby is delivered,” Dr. DiLeo says, “so long as it doesn’t harm you or your baby.” The American College of Obstetricians and Gynecologists sanctions the use of Pitocin to induce labor for convenience once a woman has reached her 39th week of pregnancy and her cervix is ripe, he adds. To determine whether or not a cervix is ripe, doctors check a woman’s Bishop’s Score, a numerical score based on dilatation, thinning (effacement) and head descent, explains Dr. Kritz.

Not all delivery practitioners and medical institutions agree with the American College of Obstetricians and Gynecologists’ sanctions, however. Ratta explains that Massachusetts General’s protocol states that inductions may not be done until the 41st week of pregnancy, if the cervix is ripe, and the patient desires. This time frame is based on research that indicates a baby may not remain healthy in the womb once week 42 has passed. After week 42, the baby can outgrow its supply of placenta, and the remaining amniotic fluid may not be sufficient to sustain the baby’s metabolic needs, says Dr. Kritz.

The Risks

So, you’ve reached week 40 and you want your baby delivered—now. You may request an induction from your doctor, if your cervix is ripe. According to Dr. Kritz, Pitocin used to induce before the cervix has softened can cause serious complications including a risk of placental abruption or harm to your baby.

“If your body goes into labor, your body is saying, ‘I’m ready to deliver.’ If your labor is artificially induced, it likely won’t work as well, and your body might stop midway,” says Ratta. In other words, if your cervix isn’t ripe, your body is not ready to deliver, and an induction will increase your risk of an emergency C-section.

Another risk is posed when “Pitocin is used incorrectly and causes hyper-stimulation, which brings on a ‘mother’ contraction, [which impacts the supply of blood and oxygen to the fetus] and affects the heart rate of the baby [fetal distress],” explains Dr. DiLeo. Sometimes, though, these mother contractions, called tetanic contractions, are simply fluke reactions to the drug. “In rare cases, [these strong contractions] can lead to tearing of the uterus,” states the USP Drug Guide.

Making a Choice

Any pregnant woman may find herself in a position where she needs to be induced for medical reasons, and all moms-to-be should be aware of this possibility. Induced births are often wonderful experiences, and fortunately with modern medicine it is possible to induce delivery of a baby who might otherwise suffer from serious health risks.

But, when faced with the option of an induction, especially a selective one, women need to know of the risks and the facts. In deciding which kind of delivery practitioner you want to use, consider each one’s stance on drug-induced labor.

Doula Robin Elise Weiss believes that “in general you’ll probably find OBs are quicker to jump to pit [in using Pitocin] than midwives, though it’s certainly case by case.” In addition, an OB-GYN who works for a private practice may have a different policy on inductions than a doctor who works in a hospital setting. The latter will need to follow the hospital’s protocol, says Ratta. She adds that while she does use Pitocin in deliveries, she will not perform an induction simply because a patient requests one. “It is not what midwives do,” she says, and in fact, she “strongly advises against [a non-medically necessary induction] as it is inherently risky.”

Dr. Kritz believes that selective induction goes against the traditionally, non-interventionist philosophy of the family practitioner, as well. If she induces a delivery, it is typically because a woman has gone into labor on her own but is not progressing.

Expecting women also need to think about the delivery process and their faith in their bodies. “I think Pitocin is over-used in many ways,” says Weiss. “You see it used routinely for the delivery of the placenta, rather than waiting or allowing nature to take its course. At the births I’ve been present at, I find it being used more and more, particularly without waiting for the woman’s body to kick in.” That said, many women don’t mind not waiting for their bodies to kick in and prefer to be in control of the labor experience. As long as they understand that “Pitocin is not a benign drug,” warns Dr. Kritz. Pitocin, like “any medication used well, can be wonderful, and like any medication used improperly, can be a disaster,” says Dr. DiLeo.

Given the ease with which doctors induce, many women when offered the possibility of ending their pregnancies early, feel thrilled, but are simply never made aware of the risks. Many women are uninformed, says Ratta, and it is left to the physician, who is often pressed for time, to teach them. “I don’t believe women get true informed consent, about most anything, including Pitocin,” says Weiss. Informed as pregnant women may be, once in the delivery room—in labor, and possibly on painkillers—many women feel vulnerable. A birth plan that takes many different possibilities into account can help you be prepared, and empowered to make decisions consistent with your personal needs and values should any unexpected events occur during delivery. In the end, remember that the most important part of the delivery process is the little person you’re delivering.

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