Clingon

Induced Labor: When is it Appropriate?

By Anne Clingon Teacher: Ms. Robin Hol I!M health science "th period #ece$ber %& '(%)

Clingon

Induction o* labor in recent years has beco$e +uite contro,ersial. While $any -o$en are e.cited at any -ay to $a e their pregnancy $ore con,enient& other -o$en *eel that induction is an alternati,e that no -o$an -ould choose i* she ne- the ris *actors. Inductions are so$eti$es necessary *or the health o* a baby in cases such as hypertension or diabetes. Ho-e,er& there has been a recent trend o* inductions *or con,enience. In the past '( years alone the nu$ber o* electi,e inductions has increased *ro$ % in %( to no- % in ) births /Association o* Wo$en0s Health& 1bstetric and 2eonatal 2urses3. Many physicians and $others are le*t -ith the decision o* -hether or not these electi,e inductions are sa*e. Health pro*essionals $ust -or together to educate $others and decrease the nu$ber o* electi,e inductions *or the sa*ety o* $others and babies. Although induced labor is so$eti$es necessary& -o$en -ho choose this option ha,e increased le,els o* co$plications and ris s including cesarean sections& pre$ature babies& uterine atony& and postpartu$ he$orrhage. There are so$e instances -here an induced labor $ay be necessary such as -hen the $other has gestational hypertension& diabetes& pre,ious stillbirths or a placenta that is no longer correctly *unctioning. When a -o$an has gestational hypertension and does not $anage her blood pressure le,els she so$eti$es -ill be induced but i* she eeps her blood pressure le,els in a good range she can so$eti$es a,oid an induction *or that reason. Wo$en -ith gestational diabetes are also induced so$eti$es because o* the large si4e o* their babies and a *ear that -ith $ore -ee s the baby -ill need to be deli,ered ,ia C5!ection because they -ould not *it through the birth canal and *inally -o$en -ho ha,e gestational diabetes are at a greater ris o* still birth

Clingon as the pregnancy progresses so so$e doctors -ill induce their patients then. Wo$en -ith diabetes ha,e the sa$e ris s o* too large children and stillbirths as those -ith gestational hypertension and there*ore they are at a higher ris *or an induction. As the pregnancy progresses the li elihood o* a $other to ha,e a still birth increases and there*ore -o$en -ho ha,e had a pre,ious still birth are at a higher ris to ha,e another and there*ore and it is $ore co$$on *or the$ to undergo an induction earlier in pregnancy to pre,ent another still birth. Whene,er a placenta is no longer correctly *unctioning& an induction is a -ise choice because the baby is no longer getting enough nutrition o.ygen and all other things that co$e *or$ the placenta -hich is the baby0s only li*e source. !o$eti$es the placenta only -or s *or )6 -ee s so an induction is necessary *or the baby to be able to get another 7source o* li*e8. Wo$en -ho ha,e inductions are t-ice as li ely to need Cesarean !ections as those -ho e.perience spontaneous labor and there can be $any co$plications -ith the operation /Ti**any 10Callaghan3. A co$$on $ethod used in induction is arti*icially rupturing the a$niotic sac. 1nce the a$niotic sac has been ruptured *or an e.tended ti$e& in*ection beco$es $ore li ely. In*ection can lead to co$plications including the death o* the $other or her baby. There*ore i* in*ection is suspected& a cesarean section $ay be done to sa,e the $other and baby. When a -o$an0s labor is started by an induction -ith a $edication called 9itocin& there is al-ays a chance that it -ill not -or properly as it a**ects all -o$en at di**erent rates. Because o* the -ide ranging e**ects o* a 9itocin induction so$e -o$en -ho do not progress substantially in the *irst se,eral hours decide the$sel,es that the stress is too $uch and that they -ould li e to ha,e a cesarean section. !o$e -o$en $ay be induced be*ore their baby has reached the proper positioning to be deli,ered sa*ely. In the last *e- -ee s o* pregnancy that are $issed by an early electi,e induction the baby drops do-n naturally into the pel,is and the cer,i. tilts *or-ard and

Clingon so*tens -hile irregular contractions help the cer,i. thin and begin to dilate /A,oiding Induced Labor is More bene*icial to Mo$s and Babies3. Whene,er this does not happen properly during an induction there is an increased ris o* a cesarean section because o* sa*ety issues concerning the baby0s position and progress through the birth canal. When a -o$an goes through a cesarean section $any *orget that it is a $a:or surgery; they *eel sa*e about it because $ost o* the ti$e they -or ,ery -ell -ith little co$plications and are +uite co$$on -ith about )%< o* all -o$en ha,ing one /10Callaghan3. Ho-e,er there are co$plications *ro$ cesarean sections such as bleeding& adhesions& abnor$al placenta i$plantation in *uture pregnancies and in*ection. Researchers ha,e *ound that under ne-ly i$ple$ented policies o* restricted a$ounts o* electi,e inductions the o,erall induction rates dropped ))< and there*ore in e**ect the nu$ber o* C5 !ections a$ong *irst ti$e $others undergoing electi,e inductions dropped =(< /10Callaghan3. Inductions that are planned too early can lead to pre$ature birth. 2either doctors nor $others can deter$ine the due date -ith %((< accuracy and there*ore a birth $ay be induced accidentally be*ore the in*ant is at *ull ter$. A scheduled induction *or )> -ee s could *or e.a$ple lead to gi,ing birth to a baby -ho is only in reality )= -ee s gestation. 9reter$ babies are at ris *or se,eral postnatal co$plications and according to a study published in The ?ournal o* the A$erican Medical Association babies born only a *e- -ee s early& at )@ through )= -ee s& -ere nearly ) ti$es $ore li ely to die -ithin the *irst year o* li*e than *ull ter$ in*ants /The society *or Maternal5Aetal Medicine %3. In the last *e- -ee s o* pregnancy ,ital gro-th happens -ith the baby0s lung $aturity and protecti,e layers o* *at. Because de,elop$ent o* the lungs continues e,en into early childhood respiratory $orbidity is co$$on -ithin ne-borns deli,ered in early ter$. A$ong all in*ants deli,ered at )" -ee s there -ere higher rates o* respiratory *ailure than in*ants deli,ered at )> -ee s gestation and there are as -ell higher rates

Clingon o* respiratory distress syndro$e& transient tachypnea o* the ne-born& pneu$onia and sur*actant and oscillator use that ha,e been reported *or in*ants deli,ered -ithin early ter$ in contrast -ith those deli,ered at )> -ee s gestation or beyond /The !ociety *or Maternal5Aetal Medicine '3. In addition those babies -ho -ere deli,ered e,en se,eral days be*ore )> -ee s gestation still had a signi*icantly increased ris o* health proble$s. There*ore it has been concluded that scheduling inductions or cesarean sections e,en a *e- days be*ore )> -ee s gestation should in all cases be a,oided /Co$$ittee 1pinion B=%3 . Many babies that are that are deli,ered electi,ely are ad$itted to the neonatal intensi,e care unit /2ICC3. A co$parison o* 2ICC ad$ission rates *or ne-borns deli,ered at )"& )6 and )> -ee s gestation re,ealed that )%< o* deli,eries had no $edical indication and that 2ICC ad$ission -as re+uired *or %".6< o* in*ants deli,ered -ithout $edical indication at )" -ee s gestation and *or 6< deli,ered -ithout $edical indication at )6 -ee s gestation contrasted to only @.=< o* in*ants deli,ered )> -ee s gestation and beyond. According to a study the ris o* B $inute Apgar scores /a si$ple assess$ent o* ne-born health3 less than " out o* %( on the Apgar scale decreased *ro$ %.%(< at )" -ee s gestation to (.=>< at )6 -ee s gestation and (.=%< at )> -ee s gestation /Co$$ittee 1pinion B=%3 Mortality rates too are higher a$ong ne-borns and in*ants deli,ered during early ter$ in contrast to those deli,ered at *ull ter$. The relati,e ris o* neonatal $ortality in re*erence to )> -ee s gestation is '.)< at )" -ee s gestation and %.@< at )6 -ee s gestation. In conclusion it is ,ery i$portant *or -o$en to -ait *or their babies to reach *ull $aturity be*ore choosing an electi,e deli,ery. Because o* the uncertainty o* due dates electi,e inductions can lead to pre$ature babies and the only -ay to be certain that the baby is *ully de,eloped is to -ait *or labor to spontaneously occur on its o-n -hen the baby is ready.

Clingon With inductions one o* the $ost co$$on and so$eti$es e,en deadly in rare occasions occurrences can be uterine atony -hich is the *ailure o* the uterine $uscles to contract properly a*ter the baby and placenta ha,e deli,ered. The blood ,essels that supplied the placenta during pregnancy are se,ered -hen the placenta separates *ro$ the -all o* the uterus. The bleeding that results *ro$ these se,ered blood ,essels usually stops -hene,er the uterus contracts and co$presses the ,essels. Ho-e,er -hen the uterus does not contract enough the bleeding $ay continue and signi*icant blood loss $ay occur. Inductions are not the only cause o* uterine atony but they are a$ong the leading causes. When a -o$an is induced using 9itocin it $anually $a es her ha,e contractions and there*ore the baby is deli,ered -hene,er con,enient. Ho-e,er a*ter the $other gi,es birth and the 9itocin is stopped& so$eti$es her uterus -ill cease to contract. There*ore she -ill bleed as result o* uterine atony until she is gi,en $ore 9itocin or an alternate treat$ent is used. 1ne o* the other biggest reasons *or uterine atony is a prolonged labor -hich can easily co$e about *ro$ an induction. When the induction ta es a long ti$e then the uterus is contracting *or a ,ey e.tended a$ount o* ti$e and it can get tired :ust as all other $uscles can. There*ore a*ter the birth the uterus does not contract any $ore because it is out o* energy and then bleeding $ay occur on large le,els *ro$ the lac o* contractions o* the blood ,essels. In addition -hene,er *rag$ents o* the placenta are le*t re$aining in the uterus& -hich is $ore co$$on a*ter a 9itocin induction& the uterus $ay ha,e trouble contracting and this too can lead to uterine atony. When the uterine atony is not *i.ed +uic ly enough the $other can bleed e.cessi,e a$ounts and she $ay need blood trans*usions and she can e,en die. Inductions put $others at a higher ris *or uterine atony& -hich is yet another reason that they should be a,oided and that instead a spontaneous labor should be allo-ed to occur.

Clingon 1,erall there are so$e occasions and certain situations in -hich an induced labor $ay be the sa*est thing to do. In *act -hen $edically necessary& inducing labor can be a li*e sa,ing procedure. Ho-e,er in $any cases an electi,e induction0s con,enience is se,erely out-eighed by the possible and li ely ris s that they pose. Wo$en are better o** -aiting *or spontaneous labor -here the co$plications are $ini$al and not li ely in contrast to elected inductions.

Citations: AC1D. E2on Medically Indicated Farly5Ter$ #eli,eries.E Committee Opinion /'(%)3: n. pag. Apr. '(%). Web. % #ec. '(%).

EAtony o* the Cterus: What Is the Hidden #anger?E Healthlines RSS News. 2.p.& n.d. Web. (% #ec. '(%). EA,oiding Induced Labor Is More Bene*icial To Mo$s and Babies.E Medical News Today. MediLe.icon International& n.d. Web. (% #ec. '(%).

7Leading 2ursing ?ournal F,aluates the F**ect o* I$ple$enting 9olicies Ai$ed at Increasing !pontaneous Labor.8 Association o* Wo$en0s Health& 1bstetric and 2eonatal 2urses /AWH1223. 2.p.& n.d. Web. %" 2o,. '(%)

Ro$ano& A$y.89ro$oting& 9rotecting& and !upporting 2or$al Birth: A Loo at the F,idence. 7?ournal o* 1bstetric& Dynecologic& G 2eonatal 2ursing. Wiley 1nline Library. AWH122& ?anuary ''& '((6. Web. %' 1ct '(%)

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AC1D. ECo$$ittee 1pinion B=%.E The American College of Obstetrics and Gynecologists. 2.p.& Apr. '(%). Web.