Induction

Littles was born via induction, due to being two weeks late.

Labor induction is the subject of much debate, for a variety of reasons. For one, it's on the rise: Approximately 1 in 4 labors in the USA now start via induction, and it appears that much of the increase is due to elective (rather than medically-indicated) inductions. "Early term" elective inductions (at 37 or 38 weeks gestation) are associated with a significantly higher rate of NICU stays and other complications, compared to inductions at 39 weeks or later. Pitocin, a drug used in many of those inductions, has the reputation of stimulating contractions that are far stronger than contractions experienced during a spontaneous labor, dramatically increasing the likelihood that the mother will need an epidural. And since by definition, induction is designed to make a body give birth before it's ready, it has the reputation of greatly increasing the risk of ending up with a c-section.

These reputations are so pervasive that I've heard women say things like, "I knew the Pitocin-induced contractions would be awful, so I refused to let them start Pitocin until I had my epidural." Or, "My OB is talking induction, but I'm thinking it would be better to just accept the inevitable, and have a scheduled c-section. Better than an emergency one after a failed induction."

Simply put, this wasn't my experience. I labored on Pitocin for nearly 12 hours with no epidural or other pain medications. I ended up delivering vaginally with no complications. Even now, having experienced two spontaneous labors, I still consider Littles' birth to be a wonderful experience -- very different from my other two births, to be sure, but amazing in its own way. I also didn't find Pitocin-induced contractions to be any different from the spontaneous contractions of Noob's and Q's births. The main challenge in Littles' birth was just that it took much longer -- roughly 11 hours of truly "active" labor, compared to about 4 hours with Noob and maybe 2 hours with Q. The individual contractions weren't any harder to deal with; there were just a lot more of them to deal with :)

Numerous studies back up my experience. For example, this study, this study, and this systemic review all found that inducing labor does not raise the risk of a c-section, and may actually result in lower c-section rates in certain populations, e.g. women at or beyond 41 weeks gestation. And in the seminal Dublin study on active management of labor, 25% of labors were induced (via amniotomy followed by oxytocin [Pitocin] if contractions didn't start on their own) and 55% of labors were augmented with oxytocin at some point, yet the c-section rate was only 5.2% and nearly half the women in the study did not receive any pain medication.

(As for the issues associated with "early term" elective inductions? Those are definitely real, and are the reason for a March of Dimes campaign against such inductions.)

Okay. Studies are great and all, but it really seems like most of the moms I know who went in for an induction walked out with a c-section. Especially the first-time moms. And when I hear their birth stories, I often find myself shaking my head at some of the unnecessary hoops they were forced to jump through. Like the women who were forced to stay in bed for the duration of their induction. Or who were only allowed ice chips for sustenance.

The natural-birth community loves to vilify Pitocin, but this gap between the studies and my reality makes me wonder whether the problem is not Pitocin per se, but how it's used, or abused, as the case may be. For example, in the aforementioned Dublin study, each laboring woman was assigned a personal nurse for support -- essentially a doula. The mere presence of a doula has been shown to lower epidural rates and c-section rates. Perhaps that helps account for some of the study's results despite the relatively high reliance on Pitocin.

If that's the case, it is good news, because it means that women can do something to improve their chances of a successful induction. In my next few posts, I'll talk about some of the things that I believe helped with making my own induction successful.