Before consenting to having their labors induced, as an ever-increasing number of women are being asked to do, women must beforehand know the substantial risks involved. Following are a small sample of studies and research showing that inductions lead to cesareans, instrumental delivery, shoulder dystocia (from the pelvis not being allowed to naturally relax and open to allow the proper passage of the baby), death, and more.
“Ritual” induction at 41 weeks gestation is based on flawed evidence
Following are quotes from: Routine induction of labour at 41 weeks gestation: nonsensus consensus
“The higher risk that routine induction at 41 weeks aims to reduce is dubious, if it exists at all.”
“Over 99% of the supposedly compromised fetuses detected by monitoring most likely were not, but were rescued from normalcy by operative delivery for enhanced provider and patient anxiety.” “Assuming a rate of caesarean section of 16% in women starting spontaneous labour, regardless of intention-to-treat allocation, one would obtain a caesarean rate of 16% in women who laboured spontaneously compared with 29% in those who were induced.”
“…it is uncertain that routine induction at 41 weeks will reduce the number of fetuses who die, and it is arguable that such practice could increase perinatal mortality and morbidity.” “A mother randomised to induction was induced, with prostaglandin. Precipitate labour ensued, with rapid progress to full dilation, severe decelerations, forceps rotation and extraction. The baby sustained high cervical cord injury and quadriplegia. This complication was not identified in the publication[ 2 ], a subsequent reinterpretation[ 15 ], nor in the SOGC Clinical Practice Guidelines[ 3 ] and there was no such incident in the study’s expectant cohort.”
“Approximately one-quarter of pregnant women have not laboured by 41 weeks. Their stillbirth rate in the subsequent week without fetal surveillance is approximately 1 in 1000. Routine induction at 41 weeks is ritual induction at term, unsupported by rational evidence of benefit. It is unacceptable, illogical and unsupportable interference with a normal physiologic situation.” “Routine induction at 41 weeks is ritual induction at term, unsupported by rational evidence of benefit. It is unacceptable, illogical and unsupportable interference with a normal physiologic situation…Such interference has the potential to do more harm than good, and its resource implications are staggering. It is time for this nonsensus consensus to be withdrawn.”
Excerpted from: Routine induction of labour at 41 weeks gestation: nonsensus consensus BJOG: An International Journal of Obstetrics and Gynaecology, Volume 109, Issue 5, May 2002, Pages 485-491 Savas M. Menticoglou and Philip F. Hall.
Say “No” to Induction of Birth by Gloria Lemay
When a woman is hurried into the birth process in any way (membrane stripping, cohosh tinctures/teas, nipple stimulation, castor oil, etc.), the flow of the birth will be disturbed. One of my concerns about home inductions is that the birth which is stimulated by outside forces can result in erratic birth processes that stop and start, and are difficult to complete. I attended a Coroner’s inquest here in Vancouver into the death of a full term baby girl who was born at home. The registered midwife stripped membranes because of pressure from her licensing body to not have the mother go more than 10 days past her due date. The pregnant woman began having birth sensations right after her membranes were stripped by the midwife and she dilated to 10 cms quite quickly but she then had no urge to push. She was in second stage (fully dilated and pushing) a long time and then, when the baby’s head was visible, her perineum wouldn’t stretch. The midwives cut an episiotomy to get the baby out. Baby had bleeding in the brain and only breathed on life support. Later, after transport of baby and mother to the hospital, Mom’s placenta had to be manually removed because it wouldn’t come out. It seemed to me that this woman’s body wasn’t ready to give birth and that the membrane stripping caused an emergency response in her body that produced dilation but then didn’t complete the birth smoothly.
The risk/benefit ratio of any type of induction must be carefully weighed. The old maxim “First, do no harm” should guide any decision to meddle with Mother Nature’s plan for birth. Gail Hart, a respected midwife from Portland, Oregon, says to think of the all the factors which begin a birth naturally as a bicycle lock. Just as with a bike lock you need to have all the numbers lined up in exactly the right order for the lock to release, so does a woman/baby combination have to have all their “numbers” lined up perfectly for a smooth, flowing birth to ensue. We do not know what all these factors are and this is why inductions of any kind are so fraught with poor outcomes for the mammatoto. Being patient is the midwife’s best birth tool.
Response of Linda Hessel:
“We all want to see women empowered to make truly informed choices about their care. Unfortunately, most birthing women tend to simply trust that their birth attendant will know what is best for them. The danger of this occurring in a homebirth environment is no less than in a hospital setting and may in fact be more insidious, because while so many of us distrust the obstetrician’s medicalized approach, the homebirth midwife is regarded as especially wise in the ways of birth, as well as unintrusive and noninterventive. The definitions of these last two terms are of course relative, and midwifery, just like obstetrics, is based in traditions that are not always safe or beneficial. I came to understand this first from experience. My labor was not difficult, but it was longer than average. My midwife encouraged me to drink castor oil to speed up the process. Eager to escape the tedium of labor and to see my baby, I agreed. It was a huge mistake. The stomach cramping was severe and compounded the pain from my contractions, which were now coming fast and furious. Back labor was very painful [in subsequent births], yes, but do-able; my castor oil labor was a tortured hell. Now I know that I was putting my baby at risk as well. I would have much preferred the tedium of a long labor.” -Linda Hessel Peoria, OR
Advantages to Keeping the Bag of Waters Intact
-by Leilah McCracken, based on an article by midwife Gail Hart
It’s best not to do artificial rupture of the membranes (AROM) as a method of labor induction because: an intact bag allows for free movement of the baby: better likelihood of rotation (perhaps less likelihood of malpresentations like OP) an intact bag offers protection against infection
an intact bag acts as a preventive against cord prolapse an intact bag protects the baby- and the cord- from the compression of labor when the bag is intact there is less stress on the baby: a baby can handle the stress of labor far better than one without that cushion of water
the cord and even the placenta itself recover better from the squeeze of contractions (amniotomy is sometimes routinely done because it is thought to be “harmless’, and then amniofusion- putting water back into the uterus- becomes necessary to relieve cord compression and improve the fetal heart tones- this is not safe)
if there is meconium in the waters, there should be lots of fluid in order to naturally dilute it; if the waters are ruptured, the fluid becomes thicker and often more meconium stained than before an intact bag gives mom time to finish dilating and the baby can handle a longer labor shoulder dystocia is may be less common if AROM isn’t done- the extra body of fluid might allow more movement and lubrication which might help avoid malrotation of shoulders.
An intact bag is more respectful to the baby- why introduce fingers and hooks into the internal environment?- this is a violent act.