These days, it’s very common for parents-to-be to face an important decision: whether to induce labour or wait for labour to begin spontaneously.
An induction of labour is when labour is started artificially, usually with a synthetic form of oxytocin (Syntocinon or Pitocin).
Women and their partners should be aware that, for a low risk pregnancy, induction of labour introduces a number of risks to a potentially normal labour and birth.
Many parents are not aware of the reasons why waiting for labour to start without any interference is preferable, and beneficial, when there are no medical complications.
Unfortunately, it’s not as simple as having some medication and then having labour begin (and end) just as it would normally. The reality is actually very different.
Here are some of the many differences between a natural labour, which begins spontaneously, and one that is started artificially.
#1: Labour Hormones Work Differently
When you go into labour spontaneously, oxytocin is released to stimulate contractions in the uterus.
Oyxtocin acts like a key to unlock the oxytocin receptors in your uterus.
During the first and second trimesters of pregnancy, your uterus has few receptors, to protect you from going into labour too early.
As you reach full term, the number of receptors increases significantly.
Once labour begins, they are activated by the oxytocin in your bloodstream. Then they work effectively to contract the muscle, and dilate the cervix.
The oxytocin is released in a pulsing action, and comes in waves. This is so your uterus is not continuously contracting or having very strong contractions from the start.
Oxytocin levels also increase gradually. At the start of labour, contractions might come every 20-30 minutes, and last around 30 seconds. As the tempo of labour increases, the contractions will get closer together (2-5 minutes apart) and longer (60-120 seconds in length).
This progression of natural labour usually happens over 10 or so hours, so that you have plenty of rest time between contractions, and your body is able to adjust to the intensity of contractions over time.
When you are induced, it’s likely to happen before your body and baby are ready. This can mean there aren’t enough receptors available in your uterus, and so a large amount of synthetic oxytocin is required to start labour and to keep contractions going over time.
The artificial oxytocin level is increased until you are having 3-4 contractions in a 10 minute period. Each contraction should last 40-60 seconds, and there should be at least a minute between each contraction.
Syntocinon or Pitocin is given to you continuously, via IV. Your uterus goes literally from standstill to contracting ‘X' number of times in an hour. This means the contractions are very long and strong from the start, and your body doesn’t get a break.
And of course, once you hop on the induction train, you can't get off or make it stop. You're now committed to getting your baby out, even if that means via c-section.
#2: Contraction Pain Is Different
The main difference between a natural and artificially started labour is the intensity of the contractions.
In a natural labour, oxytocin works to stimulate your uterus to contract and dilate the cervix.
As the cervix stretches, pain receptors send messages to the brain, which responds by releasing endorphins. This substance is ten times more powerful than morphine, and acts to counteract the sensation of pain. As oxytocin levels increase, more endorphins are released.
When labour is induced, the artificial oxytocin used to stimulate contractions does not cross the blood-brain barrier. Your body doesn’t receive signals to release the endorphins and you experience more intense pain.
Natural labour usually begins slowly, with a gradual build up of spaced out contractions that are short and mild. Over time, these contractions get closer together, longer, and more intense.
During an induced labour, this can’t happen. The intense pain begins immediately. Your brain can’t respond to the pain of these contractions, and is not able to ‘be involved’ in the labour. As a result, you’re more likely to request pain relief, such as an epidural.
#3: Movement During Labour Is Different
In a natural labour, women usually seek out the positions and places in which they feel most comfortable. During early labour, you might want to move during contractions, which helps your baby to find the optimal position for birth.
In late labour and in transition, you might seek the comfort of a warm bath or shower. Your partner or birth support can support you during the pushing stage, encouraging your baby to move down and using gravity to assist.
During an induced labour, it is recommended that you have constant monitoring at the beginning, and then intermittent monitoring, unless there is an indication of fetal distress. This is because the labour is now high risk. You will also have an IV drip attached. These limit your ability to move freely and work with your body, and your baby, during labour.
You are less likely to have access to a shower and won’t be able to use a birth pool to ease the pain of contractions. If you have an epidural in place (which is more likely with an induction of labour), you will be either lying on your side or sitting up in bed. This increases the risk of fetal distress, and the likelihood of a c-section.
#4: The Fetal Ejection Reflex Only Occurs In Natural Labour
The fetal ejection reflex was first discovered by Niles Newton in the 1960s. The reflex involves a powerful and uncontrollable urge to push, as if the body has flicked a switch and is ready to ‘eject' the baby.
In a natural labour, oxytocin levels increase steadily, culminating in a huge flood of the hormone when the cervix is dilated. This oxytocin peak stimulates the powerful and irresistible contractions that push the baby down and out. This is the fetal ejection reflex. Adrenaline is also released at the same time, to provide you with the energy and alertness you need to birth your baby.
During an induced labour, this oxytocin peak doesn’t happen. The synthetic oxytocin is provided by a pump and cannot be increased to offer this boost at the end of labour. If you are induced with synthetic oxytocin, or have an epidural during labour, you will not experience a fetal ejection reflex. Women who have induced labours often require interventions at this stage of labour, such as ventouse or forceps (which also means an episiotomy), to help the baby be born.
#5: Natural Oxytocin Protects Baby’s Brain
In a natural labour, the oxytocin your body produces crossed the placenta. The oxytocin ‘silences’ your baby’s brain during labour and protects it from damage that could occur due to oxygen deprivation. As contractions begin slowly and build up, oxytocin levels also increase simultaneously. This helps to keep your baby safe.
During an induced labour, the synthetic oxytocin interferes with your body’s ability to produce its own hormone. Therefore your baby is much more likely to be exposed to hypoxia (oxygen deprivation) during an induced labour. Your baby will respond to this situation by showing symptoms of distress. The most notable is when the heart rate does not pick up sufficiently after contractions. If this continues, your care provider will recommend an emergency c-section to avoid possible brain damage to your baby.
#6: The Third Stage Of Labour Is Different
When your baby is born after a natural labour, your body is on an oxytocin high. In fact, you’ll never experience an oxytocin high like this in your life. Oxytocin, the ‘hormone of love', is responsible for promoting the bonding that happens between you and your baby. This bonding is critical for your baby’s survival, but also has an important effect on your body.
As the empty uterus contracts down, the placenta sheers away from the uterine wall. Exposed blood vessels are clamped, and any post birth bleeding should be minimal. In most cases, this happens without any interference from care providers. It is called a physiological or natural third stage.
Many hospitals prefer to give women an injection of synthetic oxytocin as the baby is being born. This speeds up the third stage, and potentially reduces the risk of excessive bleeding after birth (postpartum haemorrhage). However, women who have experienced a spontaneous, undisturbed labour are less likely to require this injection, as their own bodies will produce oxytocin in large enough amounts.
If you have an induced labour, you will not experience that last boost of oxytocin naturally. The empty uterus might not be able to contract down effectively, increasing the risk of postpartum haemorrhage (PPH). The injection would most likely be necessary, at this stage, to avoid potential PPH. Find out more about how inductions increase the risk of PPH.
Synthetic Oxytocin Can Affect Bonding
Below is a clip from the world's most famous Obstetrician, Michel Odent. He explains how, in an induced labour, bonding behaviours in the mother are affected, because the mother is not releasing her own oxytocin. Sadly, the number of women going into labour naturally is decreasing at an alarming rate.
A growing amount of research appears to confirm Odent’s long held beliefs. When synthetic oxytocin interferes with natural labour hormones, it can influence a mother’s stress, mood, and behaviour. Coupled with plummeting rates of breastfeeding (another source of natural oxytocin), could this have anything to do with our high rates of postnatal depression and anxiety?
Having A Positive, Empowered Induction Of Labour
If you need to have an induction of labour, it is still possible to be empowered and have a positive experience .
See our article 8 Tips For A Positive Induction Of Labour.
You might also like to read Why All Inductions Aren't The Same – 5 Different Induction Methods.
If you are presented with the option of an induction of labour, you might want to ask your care provider whether it’s required for a genuine medical reason. Ask, for example, if there is proof in the form of a test, or abnormal results. Or whether waiting, with patience, is the better answer.
Making a comparison between natural labour and an induced one is dependent on many factors. There is no simple guarantee that your choice is the right one. The best you can do is ensure you’re aware of the differences, and the risks. And avoid making a choice based on convenience.