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Choices in Birth: Induction and Cesarean Section

Saturday, 12 October 2013 15:29
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When it comes to birth, there are so many options and so many questions to think about it is enough to make any mother's head spin.  Should I consent to cervical checks? My provider is talking induction, is that a good choice for me? While every mother has the right to make a decision for herself and for her child, those decisions can be difficult when you don’t know the facts. Listed here are a few of your options in birth, along with the pros and cons of each. When you educate yourself on your birth choices, you are more likely to do what you feel is best for you and for your baby. You’re also more likely to have positive feelings about your birth experience.

Inductions have become very common.  The rate of induced labor was as high as 23% by 20091. It is suggested that the rate of induction is as high as 42% (possibly higher in some areas) as of 20122. A medical induction of labor typically consists of a vaginal suppository such as Cervidil, or Pitocin given via intravenous line, the use of a Foley catheter, or sometimes by additional methods or a combination of two ore more methods. Sometimes inductions are used for medical purposes, when baby needs to come out quickly but mom wishes to try to avoid a cesarean. Others are “elective” inductions.

Perhaps mom wants to induce labor because her pregnancy is difficult and/or she is tired of being pregnant. In some cases, the birth is to be scheduled for a convenient date. In other cases, the mother has talked to her provider and has been convinced that induction is a good way to go. In some instances it is suspected that she is carrying a large baby that will only get larger and more difficult to push out, or perhaps the baby is full- or post-term. For some mothers, knowing that they will have their baby in their arms by a certain date brings them relief and they are more comfortable with that. 

Inductions CAN be beneficial at times. If mom has a medical problem and continuing the pregnancy poses more of a hazard for baby than letting him continue to grow undisturbed (such as preeclampsia, diabetes, kidney disease, or cancer), the benefits for an induction for mom and baby may very well outweigh the risks. 

Induction can be beneficial to mom and baby depending on different factors. If it is medically indicated that the baby needs to be born sooner, induction may be the way to go. And in many full-term mothers and babies, induction is successful. If the cervix is favorable and baby is ready, an induction can go smoothly and without any complications. But medical evidence (such as a high cesarean rate of 1 in 3 mothers4) indicates that if mom and baby are healthy, it is best to allow baby to come when he is ready. Check out the Bishop Score (a tool used to predict how successful an induction may be) and talk with your provider for more information on risks and benefits associated with induction of labor.

However, an induction can make labor more difficult. In many hospitals, it is common practice to require induced mothers to be hooked up to an IV, a blood pressure cuff, and to external fetal monitors due to the increased risks. For most women who wish to remain active in their labor, this can prove to be an issue. It is difficult to remain mobile when you are tethered to so many machines that have short cords. Medications used to induce labor such as Pitocin can trigger unnaturally strong and irregular contractions, which sometimes come without a break in between. For some mothers, these contractions are too painful and they request an epidural, which has risks of its own and may lead to birth by forceps, vacuum extraction or cesarean section.

For most low-risk pregnancies where mom and baby are both healthy, an unnecessary induction of labor can carry more risk of harm to both than benefits. For the first time mother, an induction of labor more than doubles her risk of a cesarean section3. Since there is no way to be absolutely certain of how far along a mother is in her pregnancy (unless she is 100% sure of her conception date), there is always a risk of inducing a baby that is not ready to be born. Some mothers have electively been induced only to realize that their baby's lungs were not fully developed, and that their baby was a lot smaller than previously estimated. 

Sometimes induction doesn’t work for mother and baby, or it has undesired results. Inducing agents can cause fetal distress, or in rare cases, uterine rupture- which can be an emergency situation. In some cases where the mother has an unfavorable cervix, induction doesn’t work or baby becomes distressed, ultimately resulting in a cesarean section.

For some mothers, they are unsure whether they wish to have a vaginal birth or to opt for a cesarean birth. A cesarean birth has its pros and cons. By acquiring knowledge on the topic of cesarean birth, you can make the best decision for yourself and for your baby.

A cesarean birth has some perks. For the percentage of women who fear the pain of labor and/or the pushing phase of birth, a cesarean birth may be preferred.  Other mothers wish to have a set date for their baby to be born versus going into labor at what may be an inconvenient time. In some cases, it is thought that a mother’s pelvis is too small for her to birth vaginally. Vaginal birth after cesarean (VBAC) is not an option for her so she opts for a cesarean delivery. A mother who delivers by cesarean without being in labor will typically not have the soreness, nor any tears or stitches associated with a vaginal delivery. She will not be in labor for hours on end; in a scheduled cesarean section a baby can be born within the hour, then mom and baby will be sent off to their recovery room and/or nursery.

A cesarean delivery also has its downsides. While it can be a lifesaving procedure, medical evidence indicates that when used for convenience rather than necessity, a cesarean delivery may pose more health risks for both mother and baby5

For baby, risks are minimal but include risk of being cut. Risks to baby are also similar to induction risk in the sense of scheduling a cesarean too early and baby being born prematurely. For mother there are more risks6. There are immediate risks of hemorrhage, infection, of medical supplies being left inside the abdominal cavity, of other organs being damaged, of blood clots of the leg or lungs, or in very rare cases, risk of death. Evidence shows that mothers who deliver by cesarean are more likely to develop adhesions from scar tissue, or to have problems with future pregnancies (for example: infertility, miscarriage, and problems such as placenta previa or placenta accreta)7. 

Postpartum, a mother who underwent a cesarean delivery will typically have a longer, more difficult recovery as she has undergone major abdominal surgery. She will have to keep an eye on her incision to be sure there is no sign of infection or it doesn't open, and the incision will have to remain clean and dry. Caring for a newborn is difficult even without having undergone surgery, so mom will need extra help if possible. 

When giving birth, you have many options and many decisions to make. Mothers can benefit from doing some extra research over the course of pregnancy. Learn about all of your options, along with the benefits and risks of each, and make the best decisions for your family. Talk with your partner and care provider and discuss your preferences and birth wishes. 


Sources


1. Care Process Model: Management of Labor Induction 2012 Update. https://kr.ihc.com/ext/Dcmnt?ncid=51061830

    Surprising Facts about birth in the United States. http://www.babycenter.com/0_surprising-facts-about-birth-in-the-united-states_1372273.bc?page=3

2. State of Maternity Care. http://www.improvingbirth.org/2012/11/state-of-maternity-care/

3. Time for a Change? Induction of Labor Increases Odds of Cesarean Delivery. http://www.theunnecesarean.com/blog/2010/8/2/time-for-a-change-induction-of-labor-increases-odds-of-cesar.html#sthash.bYYuSWTI.dpbs

   Induction of Labor. http://ican-online.org/induction-labor

   Labor Induction Boosts C-Section Risk. http://health.usnews.com/health-news/family-health/womens-health/articles/2010/06/22/labor-induction-boosts-c-section-risk

4. Why is the National US C-Section Rate So High? http://www.childbirthconnection.org/article.asp?ck=10456

    Cesarean Birth (C-Section). http://www.medicinenet.com/c-section_cesarean_birth/article.htm

    C-Section Rates in US Stabilize After Eight Years of Steady Increase. http://www.news-medical.net/news/20120619/C-section-rates-in-US-stabilize-after-eight-years-of-steady-increase.aspx

5. Pros and Cons: Elective C-Section. http://abcnews.go.com/Health/story?id=3291512&page=1

    ACOG: Vaginal Delivery Recommended Over Maternal Request Cesarean. http://www.acog.org/About_ACOG/News_Room/News_Releases/2013/Vaginal_Delivery_Recommended_Over_Maternal-Request_Cesarean

6. and 7.  Risks of a Cesarean Procedure. http://americanpregnancy.org/labornbirth/cesareanrisks.html

    C-Section: Risks. http://www.mayoclinic.com/health/c-section/MY00214/DSECTION=risks

    Cesarean Section- Risks and Complications. http://www.webmd.com/baby/tc/cesarean-section-risks-and-complications

Read 8813 times Last modified on Thursday, 17 October 2013 08:07

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