(In regards to the opening statement above, your body's natural oxytocin actually helps your body and baby relieve labor pains and other maternal changes during labor more than synthetically made oxytocin. To learn more on why this read Natural vs. Synthetic Oxytocin-aka Pitocin/Pit
- Inductions increase the risk of fetal distress and the incidence of cesarean section. Problems that are then attributed to the baby's condition rather than to their real cause-the induction.
- If this is your first baby, be especially leery of induction. You are at a much greater risk of a cesarean.
- Choose a caregiver who:
- has a low induction rate.
- doesn't induce for suspected large baby.
- at a minimum and in the absence of signs of infection, allows you twenty-four hours to begin labor on your own if membranes rupture.
- doesn't consider you overdue until at least forty-two weeks of pregnancy.
- Refuse an elective induction, that is, induction for convenience.
- Refuse an induction for a suspected large baby.
- Don't permit your due date to be changed based on an ultrasound scan unless it was done within the first thirteen weeks and the result is more than ten days earlier than your current due date.
- If you know when you got pregnant, you can refuse a sonogram for the purpose of estimating your due date. This will leave no room for an incorrect due date to be placed on your pregnancy.
- Make sure you have been drinking plenty of water to keep amniotic fluid volumes from decreasing.
- If a test of a fetal well-being is positive, insist on repeating the test or doing a different test before agreeing to an induction or cesarean section. Having two positive tests mathematically reduces the odds that the results are falsely positive.
Pros and Cons of Techniques for Inducing Labor and/or Ripening the Cervix
- Stripping/Sweeping The Membranes
- Pros: Slightly decreases the number of oxytocin inductions by reducing the number of postdates pregnancies. However, routine induction for postdates pregnancy has questionable value.
- Cons: Potential of rupturing membranes, instigating infection, or causing hemorrage if the placenta is overlaying the cervix. Does not decrease C-section rates.
- Mechanical Dilators
- Pros: Cheaper than prostaglandins.
- Cons: They may increase the odds of infection.
- Prostalandin E2 (PGE2; Cervidil or Prepidil)
- Pros: Somewhat reduces the cesarean rate compared with straight oxytocin inductions with an unripe cervix. Cervidil can be removed if it causes problem.
- Cons: Can cause uterine hyperstimulation and fetal distress. In some cases, fetal distress can lead to cesarean section, Prepidil cannot be removed once administered.
- Misoprostol (Cytotec)
- Pros: It may be more effective at ripening the cervix and inducing labor than PGE2 or oxytocin alone. Some studies show that its use reduces the cesarean rate compared with other induction methods. Much cheaper than PGE2.
- Cons: It increases the odds of both uterine hyperstimulation compared with PGE2 and and abnormal fetal heart rate resulting from uterine hyperstimulation. Uterine rupture has been reported. Once administered, its effects cannot be stopped. Studies have not established a safe, effective dose. Misoprostol was not formulated for use in inducing labor, and has not been approved by the FDA for this purpose.
- Rupturing Membranes (Amniotomy)
- Pros: In a woman on the verge of beginning labor, rupturing membranes may be enough to trigger labor. (Must be showing considerable signs such as almost complete thinning of the cervix and significant opening before this is recommended.)
- Cons: Labor is more painful. Requires an IV and electronic fetal monitoring, which have their own potential adverse effects. Often causes uterine hyperstimulation, which can lead to fetal distress. Doubles the odds of the baby being born in poor condition. Also causes increased postpartum blood loss and newborn jaundice. Blood loss and jaundice may relate to direct effects of oxytocin; increased use of IV fluids, especially IV fluids that don't contain salts; or both. Increases the risk of C-section, which also has grave potential adverse effects.
- Rupturing Membranes and Oxytocin
- Pros: One study where women were assigned to oxytocin alone or oxytocin with amniotomy concluded that doing both was the more effective option. However, a statistical analysis of that study concluded that participating obstetricians had almost certainly sabotaged the random assignment process because of their preconceived belief that amniotomy was also needed.
- Cons: Another trial that randomly assigned women to induction with early or later amniotomy found that early amniotomy was associated with increased likelihood of fetal distress and maternal infection but had no effect on cesarean rate. Three-fourths of the early-amniotomy cesareans for fetal distress were for abnormal heart rate patterns typical of umbilical cord compression due to lack of amniotic fluid.