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Natural Birth
induction help needed...
It is looking like I may end up being induced, and I am working to modfiy my birth plan accordingly. The OB had stated they would start pitocin and then later break my water possibly. I would think that I would want the opposite order(water broken before they try meds), but wanted to hear your opinions and why-especially from any 2nd time+ moms who have been through this.
I know Pitocin will make much stronger contractions and therefore increases the likelyhood I will want pain meds of some variety. Why would the Dr start the meds before breaking the water ? If you were in this position and an induction was unavoidable, in what order would you request they try alternatives to pitocin ? What alternatives would you request ?
Thanks in advance!
This discussion has been closed.
Re: induction help needed...
Consider what happens in nature... usually contractions happen before the water breaks. It is approx. 10% of moms where the water breaks before labor starts. But, 70% of moms have water that does not break until they are 7 cm or more dilated. So that is the vast majority - it usually does not happen until much later in labor.
The issue with water breaking is that it cannot be undone - and once it breaks, you are on a time limit. If the Pitocin does not work, or causes some bad side effects, it can always be turned down or turned off entirely. They cannot undo the water breaking.
Also, consider that the fluid can actually be a benefit to the baby. It equalizes the pressure so the umbilical cord does not get squeezed so hard during contractions. Contractions naturally reduce the blood flow to the baby and cause a drop in baby's heart rate... but it is usually more pronounced after the water has broken. Sometimes babies can tolerate a labor with the BOW intact, but might have some distress after the water is broken.
Also, consider that the higher the baby is, the more reason to NOT break the water because of the risk of cord prolapse. Not sure if your baby is high or not.
Finally, I encourage you to do all of your research about the different methods of induction. Look at your "Bishop score" that will tell you how "favorable" your cervix is for induction. If it is low, you might consider a cervical ripening agent before Pitocin. (However do your homework on Cytotec/misoprostol if that is offered to you - high incidence of possible bad side effects.)
Have you and your care provider ruled out all of the more "natural" methods? (Acupuncture, chiropractic, sweeping/stripping membranes, etc.)
Personally, I had to get induced with DD at nearly 42 weeks and I chose a mechanical method of induction - Foley balloon in the cervix - because it had a much lower possibility of bad side effects compared to what else I researched. That was the right choice for me at the time but you might choose something different based on your situation.
GL!
The PP gave very accurate reasons why water breaking should be the last thing that happens. I think sometimes people get water breaking confused with membrane stripping and think it should be done first.
If I absolutely had to get medically induced for bonafide medical problems, this is the order I would have things done:
1) Prostaglandin gel to ripen cervix
2) Membrane stripping
3) Pitocin
4) Artificial rupture of amniotic sac (water breaking)
One and two could be switched depending on the situation, but last week when I had an internal, my cervix was not favorable - so if that were still the case when medical induction began, the prostaglandin would have to come before membrane stripping could even be a possibility.
I did a lot of research on Cytotec vs. other prostaglandins like Cervidil and actually found that there is no research confirming it has any higher risks or more severe side effects than the others. The issue is that it was approved by the FDA for treatment of stomach ulcers - not for inducing labor, and in the rare cases of uterine rupture that occurred with it, the manufacturer had to release a statement reminding all that it is not approved for inducing labor. B/c it is not approved for such, they technically cannot do any research to determine what the likelihood of side effects for inducing labor are. However, all of the prostaglandins carry that risk, and the WHO actually encourages the use of Cytotec over some of the others.
I hope to avoid induction at all costs - so it may be a mute point, but I was bored and had a day to look into my options, so I just wanted to throw out there what I learned about Cytotec b/c I too had heard it is the worst of all of them and was surprised by what I learned when I actually looked nto it.
Rated "L" For Life Blog
Interesting!
I agree that all of the prostoglandins carry risk (as does Pitocin, or any drug really) but when I looked into the research, it seemed like the risks of the really bad stuff (uterine rupture, AFE - amniotic fluid embolism, mother and/or baby death) were higher with Cytotec than with the others. Granted, there are not any RCT I've seen but these were more retrospective analyses. Still, what I found was enough to make me uneasy about it compared with the others.
I think the reason the WHO encourages Cytotec is because it is very cheap, and it's also in a pill form so it's shelf stable, unlike other prostoglandins which require refrigeration. So for moms in many countries around the world, it is a better alternative, because they need something that is low cost and shelf stable, because they don't have access to other stuff. Especially for post-partum hemmohrage, it is really effective.
what is the reason for your induction? is it because you are past your due date? are there any problems with you or baby? BPP ok?
if everything is fine do you need to be induced? these are questions that i would ask before anything happened. if after all that i still needed an induction i would do all natural things first.
~ herbs
~ homeopathics
~ chiro
~ breast pump
~ massage
~ acupuncture/acupressure
~ membrane strip
~ then i would start with more medical things
GL!
Did you have success with the breast pump ? I was debating bringing mine to the hospital, but this might be one more reason to pack it...
Make a pregnancy ticker
You are probably right about the WHO and why they recommend it. Again, I'd prefer to avoid prostaglandin gels and being medically induced - whether it be with Cervidil or Cytotec or even with Pitocin -- I had a panic attack when the midwife even suggested this would be an option if my AFLs dropped any lower.
I was just surprised to learn about the reasoning why there was such a big fit over Cytotec -- it wasn't what I originally had thought. I was researching it b/c my mother is a retired OBGYN nurse and when we first I might need medical induction, she called her old clinic to see if there were any options of the OBs there applying prostaglandin, observing me and baby for awhile, but not have to go to the hospital (thus eliminating my option for homebirth). The only drug they had there was the Cytotec - and at first I freaked out, but then saw a bunch of reports on what the issue was which is what surprised me.
When I said the other prostaglandins have the same risks - I didn't mean "risks" in general, I mean they have the same ones as Cytotec - uterine rupture, AFE and fetal/maternal death. But because they have been specifically studied for induction, the manufacturer can report on what the likelihood of those risks are (which is low and rare). But Cytotec's manufacturers cannot b/c they have to publicly state that it shouldn't be used for inductions, so there is an assumption that it has higher rates b/c the few documented instances of these happening were very high publicity since the doctors using it this way weren't supposed to be but there's nothing but anectodal evidence that has confirmed it actually is any higher of a rate than the others.
Talking about these risks makes prostaglandin sound awful, doesn't it? But honestly, I still think prostaglandins are the lesser of all the evils involved in a medical induction.
I don't know much about the folely balloon - its not very common around here and I have had trouble finding info about it that isn't just some random midwife's website recommending it. It sounds interesting though, so for the OP - even though I didn't include that in my list of "what would I do" - hearing about it on here would make me research that option more and see if it is a viable option for me.
My labor started with my water breaking, and I'd avoid it for a few reasons. 1) there's not turning back and they'll put you on a clock. 2) when your water breaks, you lose all cushion. All pressure is HARD on your cervix. 3) Sometimes they can turn on the pitocin enough to jump start your labor and then turn it off.
Depends a little bit on where you're at, though. If you're walking around at 5cm, I might just let them break your water. If you're firm and high and a finger tip, I'd start with cervadil and see what that does before Pictocin.
Pretty much ditto everything Casebride says. There are a lot of other things I'd try before either of those.