Saturday, January 8, 2011

Let the Baby Decide: The Case Against Inducing Labor

By Nancy Griffin
Issue 105, March/April 2001

It was a sunny Friday afternoon, and Tracy was three days past the due date for her first baby. After finishing up the tenth call of the day from well-meaning but anxious friends and relatives, she headed out the door for her weekly checkup with her obstetrician. "If you don't go into labor by your next appointment, we may have to induce you," her doctor had advised. Tracy wondered if the slight menstrual-like cramps she'd had the past few days meant that something was happening at last.

At the doctor's office, a vaginal examination revealed that Tracy was 2 centimeters dilated, her cervix 80 percent effaced, with the baby at minus one station. According to an ultrasound scan, her amniotic fluid levels seemed borderline low, and because she was having mild contractions, the doctor suggested that she "go on over to the hospital and have a baby today!"

Excited, Tracy called her husband at work. He rushed to meet her at the hospital, where she was admitted and hooked up to an IV. Eight hours later, with no further progress, Tracy received an epidural, and labor was induced by the intravenous administration of the commonly used drug Pitocin. A few hours later, her bag of waters was broken artificially; 36 hours later, Tracy was recovering from a C-section after delivering a healthy, 7-pound baby girl. Why did Tracy have to undergo a C-section? What, if anything, had gone wrong?
Nearly two decades ago, Roberto Caldreyo-Barcia, MD, former president of the International Federation of Obstetricians and Gynecologists and an eminent researcher into the effects of obstetrical interventions, made the stunning statement that "Pitocin is the most abused drug in the world today."1 According to the Journal of the American Medical Association, 16 percent of expectant mothers are induced in the US; another 16 percent go into labor spontaneously but are helped along ("augmented") by Pitocin or a variety of other labor-stimulating interventions.2 Other estimates range from 12 to 60 percent of mothers, depending on whether the numbers refer to type of induction or augmentation, the population sample, or the mother's socioeconomic background.3-18

Pitocin is a synthetic oxytocin (the natural hormone that induces labor) made from pituitary extracts from various mammals, combined with acetic acid for pH adjustment and .5 percent chloretone, which acts as a preservative. The World Health Organization deplores routinely using Pitocin. The Physicians' Desk Reference says that Pitocin should be used only when medically necessary, beginning with a minimal dosage, as there's no way of predicting a pregnant woman's response. The induced mother should receive oxygen, be continuously monitored by EFM, and have competent, consistent medical supervision. At the first sign of overdosage, such as or fetal distress, Pitocin should be discontinued, and the patient treated with symptomatic and support therapy. After being induced, the laboring mother can still help her labor progress through natural techniques such as walking (if she's not had an epidural), changing positions, emptying her bladder once an hour, and nipple stimulation. 

Pitocin can cause increased pain, fetal distress, , and retained placenta; and recent research suggests that exposure to Pitocin may be a factor in causing autism.19-20
A survey by Robbie Davis-Floyd, a cultural anthropologist at the University of Texas, found that 81 percent of women in US hospitals receive Pitocin either to induce or augment their labors.21 Regardless of exactly how many labors are induced in the US today, the majority aren't medically necessary, and between 40 and 50 percent resulted in failed induction.22 A review of the medical literature on routine induction of labor reveals that disagreement among medical researchers in different countries is rampant, and no conclusive evidence exists that routine induction of labor at any gestational age improves the outcome for either mother or baby.23 Caldreyo-Barcia concluded that induction is medically required in only 3 percent of pregnancies24 and that therefore approximately 75 percent of all inductions put both the mother and baby at risk.25

The "Cultural Warping of Childbirth"
Induction of labor is defined by the American College of Obstetricians and Gynecologists (ACOG) as "the stimulation of uterine contractions before the spontaneous onset of labor for the purpose of accomplishing delivery"--that is, artificially starting a labor that has not begun naturally on its own. Augmenting labor, often confused with induction, is a slightly different process, used to help or speed up a labor that began on its own. Midwives, physicians, and other healthcare providers have been inducing labor for as long as the human race has attempted to gain control over the processes of nature. A basic fear of the natural process of childbirth has led, over many centuries, to what President of the American Foundation for Maternal-Child Health Doris Haire describes as "the cultural warping of childbirth." Justifiable fear about the possible death of a baby or mother in childbirth, combined with beliefs in magic, rituals, drugs, herbal remedies, and much later, technology, has led to the use of a whole host of "cures" for labors that didn't seem to start "on time."

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