Risks

[Gabi]

I'm going to be having a discussion with my OB tomorrow about induction. I know the circumstances under which I think induction is a good route for this baby, so I don't really want to discuss those. I want to hear if there are risks for bubs if I do have to be induced to help me to know when the benefits outweigh the risks. My OB says it would be much like normal labour, but I've heard so many women say otherwise that I think I want to go back with specific questions.

I know about the 'cascade of intervention' and have done some thinking and planning to try to avoid that just in case I have to be induced. And I know that the caesar rate is somewhat higher in first time mothers who are induced. I asked my OB about that one and his emergency caesar rate for first time mothers is the same whether or not she is induced. But are there risks to bubs? Other risks?

[paradise lost]

Induction of labour in a first time mother doubles or trebles the chance of the labour ending in c-section. C-sections are a safe mode of birth for the baby in the immediate sense, but c-section babies are more likely to need resusitation, less likely to breath well, more likely to suffer from chest infections and less likely statistically to breastfeed well (a lot of that can be down to the hospital policies, so if you have to have a section demand skin-to-skin in recovery and have them page an LC as baby is likely to be less alert than a vaginally born baby because of the drugs used in sections and the hormones and processes of vaginal birth being different with a section). Around 1-2% of section babies are cut by the surgeon's knife. Damage can range from a few stitches to lifelong scarring and i have read of one case where the eyeball was lacerated badly and had to be removed. C-sections are not safe for mothers unless the mother's life is at risk when birthing vaginally, though a section to save a baby is usually a risk mothers feel is worthwhile. They can have serious complications including severe bleeding which can lead to hysterectomy and even death. They increase the risks of all future pregnancies and they increase the risks of birth for all future babies whether vaginally or surgically born.

Induction can cause longer and stronger contractions which can be very painful (pain-scale studies have found induced contractions to be described as 70% more painful than natural labour contractions) which means more pain-relief drugs are used, each of which carries its own additional risks. There's no way of knowing beforehand if you'll feel this increased pain or not.

The same longer, stronger contractions can interrupt the bloodflow to the baby for long enough that the baby becomes distressed. In this case the drip will be turned down but if the distress continues or the labour stops the only option is c-section. There's no way of knowing if the drugs will distress the baby or not. Babies begin natural labour with a chemical chain reaction. Often a baby which is malpositioned will go post-dates while it positions itself well enough to be born safely. With induction a malpositioned baby is forced down against the cervix, which can lead to some trauma such as bruising if the baby becomes stuck. There's no way of knowing if the baby is positioned in such a way that labour will progress smoothly beforehand.

Because of the increased risk of foetal distress in inductions continuous monitoring is required for the baby's safety. CFM means mum is less able to move around in labour (some places are great at helping you and will even get you and all your various lines into the shower, others demand you stay on the bed and suggest an epidural instead ) which can lead to positional problems for bubs, which again can lead to c-section.

The prostaglandin gels inserted to riped the cervix can cause uterine rupture even in women with no prior uterine surgery. In one study the risk of rupture risk with one type of prostaglandin (cytotec, misoprostal) was found to be the same as that of spontaneously labouring VBAC women (ironic that doctors encourage one and discourage the other when the risks are the same, no?). Rupture carries a 40% chance of foetal death. There's no way of knowing if your uterus will react that way or not beforehand.

Inductions are a useful tool when a baby is showing obvious distress, such as poor intra-uterine growth or frequent dips in HR/activity. They save lives during situations like pre eclampsia, obstetric choleostasis, Type 1 diabetes pregnancies (though usually not GD pregnancies), but for normal babies and normal pregnancies they are relatively dangerous (when compared to spontaneous labour). If one MUST be induced then Foley's catheter induction is the safest because it does not cause foetal distress and is reversible if it fails.

My Ob's section rate was also the same for 1st time mothers regardless of if they were induced. But his personal c-section rate for 1st time mums was 46%. Which is mind-bogglingly, inexcuseably, high. On DD's birthday i had a homebirth rather than risking being one of the unlucky half of his patients. You might want to check your ob's ACTUAL number before trusting the comparison.

HTH

Bx

[Arimeh]

I don't know too much about inductions, but my midwife told me that the risk of uterine rupture in first time mothers who are induced, is actually higher than the risk of uterine rupture to those going for a VBAC.

On that statistic alone (assuming its true) its amazing how many people want an induction or OB's that recommend an induction be performed. Crazy.

[sunshine_sieben]

Hoobley,
You didn't really write anything I didn't know before, but I just wanted to say: great post. Fantastic overview. I will have to copy this one and send it to a friend who is considering an induction for convenience reasons - if you don't mind.

Sasa

[Tobily]

I don't know too much about inductions, but my midwife told me that the risk of uterine rupture in first time mothers who are induced, is actually higher than the risk of uterine rupture to those going for a VBAC.

On that statistic alone (assuming its true) its amazing how many people want an induction or OB's that recommend an induction be performed. Crazy.

I've done some research on this and from what I can find out the consensus seems to be that a syntocinin induction (the drip) for a first time mother carries about the same risk of uterine rupture as a vbac.

It is an absolute outrage that women are induced in ridiculously high numbers (one third of women in Qld alone) and are not told that this is a risk. Yet for women who want a vbac, this is suddenly enough of a risk that it is used as a scare tactic to talk them out of it, or as grounds to flatly refuse them a vaginal birth at all.

I also agree with Bec I would be asking more specific questions about that caesarean rate if you want an accurate picture.

[Schmickers]

What also concerns me are the questionable criteria used to recommend induction. The majority of women in Australia are either induced electively, or it is recommended for "post-dates". Most hospitals consider "post-dates" to be greater than 7 days over the due date, and do not take into consideration the condition of the baby, placental function, the certainty of dates and the previous menstrual cycle, or indeed the growing body of research that suggests that the way we calculate the due date is flawed, moreso in some ethnic groups than in others.

As eloquently outlined by Hoobley, the risks are so significant - and then roll in the risks inherent with a caesarean section, which is considerably more likely as the outcome of an induction - and you can see why many more women might opt out if given the opportunity to give a truly informed consent.

Gabi, good on you for taking the time to seek out this information.

[New Dawn]

Ok all I can tell you is that I was Induced with my 1st child and it was the same as my other to babies ( not that I knew that at the time ) for me it was very fast 3hrs which I now know is normal for me ( both DD's were the same ) They only thing that was different with DS ( induced ) to the DD's was that he need to be under oxegen (sp?) for 24 hrs because he came to quickly but like I said the girls came with the same speed and didnt need any help breathing so maybe this was due to the indution....

I know this isnt really all the facts and figgers that the others have posted but I thought I would tell what it was like with me...

I did only get the jell though because as I said DS had other ideas once the jell was put on so cant help you when it comes to the drip, I do know that with the induction I couldnt move around had to stay on the bed and sturp's were used due to been hooked up to a baby heart monertor( sp?) but once again when not induced could move about...

I hope some of this might have helped you with your decion

by the way I was indued due to very high BP at 39 weeks

[paradise lost]

No, i don't mind at all, anyone who needs this info should have it. Copy away

Bx

[Serendypyty]

Oh gosh, you girls have done a brilliant job in scaring the crap out of me, haha... I've been told it's very likely I'm going to be induced, and it's my first baby as well. My bub is very healthy and happy but with the way my BP is, it's not really healthy for me to go over my due date.

Now I'm thinking to myself that maybe I should say no to an induction and risk going over my due date so that I don't cause any unnecessary risks to the baby..

[MantaRay]

Emma, if there is no risk to mum or bub's health by going post-dates, then avoiding an induction is a good idea. However, if your bp is a concern, then it is possible that an induction is the "lesser of two evils". Talk to your care provider about your situation before making a decision. If your bp is manageable, then well and good. But if it is dangerous then an induction is probably necessary. GL.

[Gabi]

Thanks for these posts. I spoke to my doctor and had an internal today and my cervix is high, posterior, hard and closed - so no induction for me.

But I have to admit to feeling a little disheartened that there's no progress on my cervix.

[SamanthaP]

Don't be too disheartened - you're only 38 weeks!! Term is 42. Sorry to be the bearer of bad news! Chin up, it's a really good lesson in patience, which you're going to need a lot of in parenthood!

[bigbubbabelly]

I think you have put me off. Wow, there is a lot evidence to say it not good for induction. I thought it was to good to be true! I only will chose induction if my back gives out. It hard to get around when you can only crawl! But thanks for this post its been an eye opener.
Hayley

[MantaRay]

Gabi, don't despair. I saw my ob on the Thursday before DS1 was born (on his EDD actually) and she advised that I was showing no signs of going into labour. I went into labour the following evening and gave birth in the early hours of Saturday morning. So it can certainly happen quickly and without any prior indication. I know the waiting seems so long at that stage, but it will happen for you.

[Nelle]

I'm with Manta Gabi, you just never know, I never had internals, but I had an appt the day before I had Riv and I was convinced I had at least another week to go. Your bub might come tomorrow, your bub might need to bake another 3 weeks - usually our babies and bodies know what they're doing.
All the best for your wait though, it can be tiring I remember.

(interesting to read this info, I'm seriously thinking about induction for our next, if we have another, since we'll live about 50min from dh's work, and I had Si in about 50mins...)