Something about Inducing labor

Sometimes, a doctor or midwife might need to induce (bring about) labor. The decision to induce labor often is made when a woman is past her due date but labor has not yet begun or when there is concern about the baby or mother's health. Some specific reasons why labor might be induced include:

 

• A woman's water has broken (ruptured membranes), but labor has not begun on its own
  Infection inside the uterus
• Baby is growing too slowly
• Complications that arise when the mother's Rh factor is negative and her unborn baby's is positive
• Not enough amniotic fluid
• Complications, such as high blood pressure or preeclampsia
• Health problems in the mother, such as kidney disease or diabetes
• The doctor or midwife can use medicines and other methods to open a pregnant woman's cervix, stimulate contractions, and prepare for vaginal birth.

Elective labor induction has become more common in recent years. This is when labor is induced at term but for no medical reason. Some doctors may suggest elective induction due to a woman's discomfort, scheduling issues, or concern that waiting may lead to complications. But the benefits and harms of elective induction are not well understood. For instance, we do not know if elective labor induction leads to higher or lower rates of cesarean delivery compared to waiting for labor to start on its own. Yet, doctors have ways to assess risk of cesarean delivery, such as a woman's age, whether it is her first pregnancy, and the status of her cervix. Elective induction (not before 39 weeks) does not appear to affect the health of the baby.

 

If your doctor suggests inducing labor, talk to your doctor about the possible harms and benefits for both mother and baby, such as the risk of c-section and the risk of low birth weight. You will want to be sure the benefits of inducing labor outweigh the risks of induction and the risks of continuing the pregnancy.

Cesarean birth
Cesarean delivery, also called c-section, is surgery to deliver a baby. The baby is taken out through the mother's abdomen. Most cesarean births result in healthy babies and mothers. But c-section is major surgery and carries risks. Healing also takes longer than with vaginal birth.

Most healthy pregnant women with no risk factors for problems during labor or delivery have their babies vaginally. Still, the cesarean birth rate in the United States has risen greatly in recent decades. Today, nearly 1 in 3 women have babies by c-section in this country. The rate was 1 in 5 in 1995.

 

Public heath experts think that many c-sections are unnecessary. So it is important for pregnant women to get the facts about c-sections before they deliver. Women should find out what c-sections are, why they are performed, and the pros and cons of this surgery.

 

Reasons for c-sections
Your doctor might recommend a c-section if she or he thinks it is safer for you or your baby than vaginal birth. Some c-sections are planned. But most c-sections are done when unexpected problems happen during delivery. Even so, there are risks of delivering by c-section. Limited studies show that the benefits of having a c-section may outweigh the risks when:

 

• The mother is carrying more than one baby (twins, triplets, etc.)
• The mother has health problems including HIV infection, herpes infection, and heart disease
• The mother has dangerously high blood pressure
• The mother has problems with the shape of her pelvis
• There are problems with the placenta
• There are problems with the umbilical cord
• There are problems with the position of the baby, such as breech
• The baby shows signs of distress, such as a slowed heart rate
• The mother has had a previous c-section

Patient-requested c-section: Can a woman choose?
A growing number of women are asking their doctors for c-sections when there is no medical reason. Some women want a c-section because they fear the pain of childbirth. Others like the convenience of being able to decide when and how to deliver their baby. Still others fear the risks of vaginal delivery including tearing and sexual problems.

But is it safe and ethical for doctors to allow women to choose c-section? The answer is unclear. Only more research on both types of deliveries will provide the answer. In the meantime, many obstetricians feel it is their ethical obligation to talk women out of elective c-sections. Others believe that women should be able to choose a c-section if they understand the risks and benefits.

 

Experts who believe c-sections should only be performed for medical reasons point to the risks. These include infection, dangerous bleeding, blood transfusions, and blood clots. Babies born by c-section have more breathing problems right after birth. Women who have c-sections stay at the hospital for longer than women who have vaginal births. Plus, recovery from this surgery takes longer and is often more painful than that after a vaginal birth. C-sections also increase the risk of problems in future pregnancies. Women who have had c-sections have a higher risk of uterine rupture. If the uterus ruptures, the life of the baby and mother is in danger.

 

Supporters of elective c-sections say that this surgery may protect a woman's pelvic organs, reduces the risk of bowel and bladder problems, and is as safe for the baby as vaginal delivery.

 

The National Institutes of Health (NIH) and American College of Obstetricians (ACOG) agree that a doctor's decision to perform a c-section at the request of a patient should be made on a case-by-case basis and be consistent with ethical principles. ACOG states that "if the physician believes that (cesarean) delivery promotes the overall health and welfare of the woman and her fetus more than vaginal birth, he or she is ethically justified in performing" a c-section. Both organizations also say that c-section should never be scheduled before a pregnancy is 39 weeks, or the lungs are mature, unless there is medical need.

 

The c-section experience
Most c-sections are unplanned. So, learning about c-sections is important for all women who are pregnant. Whether a c-section is planned or comes up during labor, it can be a positive birth experience for many women. The overview that follows will help you to know what to expect during a nonemergency c-section and what questions to ask.

 

Before surgery
Cesarean delivery takes about 45 to 60 minutes. It takes place in an operating room. So if you were in a labor and delivery room, you will be moved to an operating room. Often, the mood of the operating room is unhurried and relaxed. A doctor will give you medicine through an epidural or spinal block, which will block the feeling of pain in part of your body but allow you to stay awake and alert. The spinal block works right away and completely numbs your body from the chest down. The epidural takes away pain, but you might be aware of some tugging or pushing. See Medical methods of pain relief for more information. Medicine that makes you fall asleep and lose all awareness is usually only used in emergency situations. Your abdomen will be cleaned and prepped. You will have an IV for fluids and medicines. A nurse will insert a catheter to drain urine from your bladder. This is to protect the bladder from harm during surgery. Your heart rate, blood pressure, and breathing also will be monitored. Questions to ask:

Can I have a support person with me during the operation?
What are my options for blocking pain?
Can I have music played during the surgery?
Will I be able to watch the surgery if I want?