Induction Dangers
Compiled by LLM
Before consenting to having their labors induced,
as an ever-increasing number of women are being
asked to do, women must beforehand know the substantial
risks involved. Following are a small sample of
studies and research showing that inductions lead
to cesareans, instrumental delivery, shoulder
dystocia (from the pelvis not being allowed to
naturally relax and open to allow the proper passage
of the baby), death, and more. Also see the Devil
Cytotec page.
Also see:
Click to view the following on this page:
Note: Most studies are not designed
to evaluate maternal mortality or morbidity or
perinatal deaths. If women or babies die due to
induction, we don't hear about it- we only her
if the induction method "worked".
"Ritual" induction
at 41 weeks gestation is based on flawed evidence
Following are quotes from: Routine
induction of labour at 41 weeks gestation: nonsensus
consensus
"The higher risk that routine induction
at 41 weeks aims to reduce is dubious, if it exists
at all."
"Over 99% of the supposedly compromised
fetuses detected by monitoring most likely were
not, but were rescued from normalcy by operative
delivery for enhanced provider and patient anxiety."
"Assuming a rate of caesarean section of
16% in women starting spontaneous labour, regardless
of intention-to-treat allocation, one would obtain
a caesarean rate of 16% in women who laboured
spontaneously compared with 29% in those who were
induced."
"...it is uncertain that routine induction
at 41 weeks will reduce the number of fetuses
who die, and it is arguable that such practice
could increase perinatal mortality and morbidity."
"A mother randomised to induction was induced,
with prostaglandin. Precipitate labour ensued,
with rapid progress to full dilation, severe decelerations,
forceps rotation and extraction. The baby sustained
high cervical cord injury and quadriplegia. This
complication was not identified in the publication[
2 ], a subsequent reinterpretation[ 15 ], nor
in the SOGC Clinical Practice Guidelines[ 3 ]
and there was no such incident in the study's
expectant cohort."
"Approximately one-quarter of pregnant women
have not laboured by 41 weeks. Their stillbirth
rate in the subsequent week without fetal surveillance
is approximately 1 in 1000. Routine induction
at 41 weeks is ritual induction at term, unsupported
by rational evidence of benefit. It is unacceptable,
illogical and unsupportable interference with
a normal physiologic situation."
"Routine induction at 41 weeks is ritual
induction at term, unsupported by rational evidence
of benefit. It is unacceptable, illogical and
unsupportable interference with a normal physiologic
situation...Such interference has the potential
to do more hard than good, and its resource implications
are staggering. It is time for this nonsensus
consensus to be withdrawn."
Excerpted from: Routine induction of labour
at 41 weeks gestation: nonsensus consensus BJOG:
An International Journal of Obstetrics and Gynaecology,
Volume 109, Issue 5, May 2002, Pages 485-491 Savas
M. Menticoglou and Philip F. Hall. To order it
online, go here.
Using Castor Oil (and other
methods of home induction) with Caution
By private birth attendant Gloria Lemay
Inducing with castor oil is not without hazard..
The action of this harsh substance is that once
swallowed the castor oil is hydrolized by intestinal
lipases to recinoleic acid- which stimulates intestinal
secretion, decreases glucose absorption and increases
intestinal motility. My question to a midwife
who says castor oil is not absorbed is 'Would
you please provide me with references for that
statement?'. I worry about women taking castor
oil because they also give their babies castor
oil as it passes through the gut. This means the
baby may pass meconium, too. If the midwife always
transports for meconium in the amniotic fluid,
this could cost the woman her planned home birth
and lead to aggressive suctioning of the newborn.
When a woman is hurried into the birth process
in any way (membrane stripping, cohosh tinctures/teas,
nipple stimulation, castor oil, etc.), the flow
of the birth will be disturbed. One of my concerns
about home inductions is that the birth which
is stimulated by outside forces can result in
erratic birth processes that stop and start, and
are difficult to complete.
I attended a Coroner's inquest here in Vancouver
into the death of a full term baby girl who was
born at home. The midwife stripped membranes because
of pressure from her licensing body to not have
the mother go more than 10 days past her due date.The
first time mom began having birth sensations right
after her membranes were stripped by the midwife
and she dilated to 10 cms quite quickly but she
then had no urge to push. She was in second stage
a long time and then, when the baby's head was
visible, her perineum wouldn't stretch. The midwives
cut an episiotomy to get the baby out. Baby had
bleeding in the brain and only breathed on life
support. Later, after transport of baby and mother
to the hospital, Mom's placenta had to be manually
removed because it wouldn't come out. It seemed
to me that this woman's body wasn't ready to give
birth and that the membrane stripping caused an
emergency response in her body that produced dilation
but then didn't complete the birth smoothly.
The risk/benefit ration of any type of induction
must be carefully weighed. The old maxim "First,
do no harm" should guide any decision to
meddle with Mother Nature's plan for birth. Gail
Hart, a respected midwife from Portland, Oregon,
says to think of the all the factors which begin
a birth naturally as a bicycle lock. Just as with
a bike lock you need to have all the numbers lined
up in exactly the right order for the lock to
release, so does a woman/baby combination have
to have all their "numbers" lined up
perfectly for a smooth, flowing birth to ensue.
We do not know what all these factors are and
this is why inductions of any kind are so fraught
with poor outcomes for the mammatoto. Being patient
is the midwife's best birth tool."
Linda Hessel responds:
"We all want to see women empowered to
make truly informed choices about their care.
Unfortunately, most birthing women tend to simply
trust that their birth attendant will know what
is best for them. The danger of this occurring
in a homebirth environment is no less than in
a hospital setting and may in fact be more insidious,
because while so many of us distrust the obstetrician's
medicalized approach, the homebirth midwife
is regarded as especially wise in the ways of
birth, as well as unintrusive and noninterventive.
The definitions of these last two terms are
of course relative, and midwifery, just like
obstetrics, is based in traditions that are
not always safe or beneficial.
I came to understand this first from experience.
My labor was not difficult, but it was longer
than average. My midwife encouraged me to drink
castor oil to speed up the process. Eager to
escape the tedium of labor and to see my baby,
I agreed. It was a huge mistake. The stomach
cramping was severe and compounded the pain
from my contractions, which were now coming
fast and furious. Back labor was very painful
[in subsequent births], yes, but do-able; my
castor oil labor was a tortured hell. Now I
know that I was putting my baby at risk as well.
I would have much preferred the tedium of a
long labor." -Linda Hessel Peoria, OR
Advantages to Keeping the
Bag of Waters Intact
-by LLM, based on an article
by midwife Gail Hart
It's best not to do artificial rupture of the
membranes (AROM) as a method of labor induction
because:
- an intact bag allows for free movement of
the baby: better likelihood of rotation (perhaps
less likelihood of malpresentations like OP)
- an intact bag offers protection against infection
- an intact bag acts as a preventive against
cord prolapse
- an intact bag protects the baby- and the cord-
from the compression of labor
- when the bag is intact there is less stress
on the baby: a baby can handle the stress of
labor far better than one without that cushion
of water
- the cord and even the placenta itself recover
better from the squeeze of contractions (amniotomy
is sometimes routinely done because it is thought
to be "harmless', and then amniofusion-
putting water back into the uterus- becomes
necessary to relieve cord compression and improve
the fetal heart tones- this is not safe)
- if there is meconium in the waters, there
should be lots of fluid in order to naturally
dilute it; if the waters are ruptured, the fluid
becomes thicker and often more meconium stained
than before
- an intact bag gives mom time to finish dilating
and the baby can handle a longer labor shoulder
dystocia is may be less common if AROM isn't
done- the extra body of fluid might allow more
movement and lubrication which might help avoid
malrotation of shoulders
- an intact bag is more respectful to the baby-
why introduce fingers and hooks into her environment?-
this can be considered a violent act.
Induction Warnings
-by Gail J. Dahl. author of Pregnancy
and Childbirth Tips. This letter originally
appeared in Midwifery Today's Birthkit, Spring
2001.
I read with shock that physicians are offering
induction at 38 weeks in the United States. I
am sure that this offering is made without informed
consent being given. Perhaps we need new warnings
like:
- Warning: Induced labor may cause permanent
brain damage to your baby.
- Warning: Induced labor may cause you to undergo
an emergency cesarean operation.
- Warning: Your baby requires 38–42 weeks
and longer for gestation. Forcing your baby
out of the womb early may cause risks and side
effects to occur to both you and your baby.
Some of these side effects may cause permanent
damage.
- Caution: Taking your baby out early by induction
drugs may permanently damage your baby’s
immune system.
- Warning: Ultrasound date estimates are often
in error by more than two weeks. Inducing a
premature baby will cause harm to both mother
and baby.
- Warning: A birth induction using the pig semen
derivative PE2 may cause you to lose your sex
drive for years.
- Warning: A birth induction may cause you to
hemorrhage during labor and for months after
the birth.
- Caution: Allowing your baby and your body
to choose the birthdate will give you a faster,
easier and safer childbirth.
Hearing the stories of women who have experienced
a failed induction and women and babies who have
experienced permanent side effects from the hormones
used to force labor is one of the saddest parts
of my day. I believe that injecting these men
who are so willing to rape our babies from our
bodies would give them a touch of how it feels
to be torn apart from the inside. I liken birth
induction to smashing a tube of toothpaste out
with a hammer. Sure you got it out, but what is
left of the baby and mother?
The artificial contractions actually slam your
baby's head into your pelvis unlike a normal contraction
that will squeeze your baby out. It is critically
important that we begin to inform young women
about the dangers and risks of this procedure
before they become pregnant, when they are open
to new information. I hope you continue to speak
up about the dangers of elective labor induction.
-Gail J. Dahl
Also by Gail J. Dahl: Whose Schedule?-
Induced Labor
and Informed Consent in Canada This is the
story of how one woman's hospital birth experience
changed her from a real estate agent into a bestselling
author and childbirth activist. A must-read!
Oxytocic Drugs
Oxytocic Drugs [ike Pitocin] are like "holding
an infant under the surface of the water, allowing
the infant to come to the surface to gasp for
air but not to breathe".
"Few childbearing women realize the inherent
risks of oxytocic drugs. In addition to the more
benign effects of uterine stimulants, the American
manufacturer of Pitocin points out in its package
insert that oxytocin can cause:
- maternal hypertensive episodes,
- cardiac arrhythmias,
- uterine spasm,
- titanic contraction,
- uterine rupture,
- subarachnoid hemorrhage,
- water intoxication,
- convulsions,
- coma,
- pelvic hemotoma,
- postpartum hemorrhage,
- afibrinogenemia,
- fetal death.
Uterine stimulants that foreshorten the oxygen-replenishing
intervals between contractions by making the contractions
too long, too strong, or too close together increase
the likelihood that fetal brain cells will die.
The situation is somewhat analogous to holding
an infant under the surface of the water, allowing
the infant to come to the surface to gasp for
air but not to breathe.
All these effects increase the possibility of
neurologic insult to the fetus. No one really
knows how often these adverse effects occur because
no law or regulation in any country requires the
doctor to report an adverse drug reaction to the
country's drug regulating agency, even if the
patient dies."
-Doris Haire, R.N., CNM "Update on Obstetric
Drugs and Procedures: Their Effects on Maternal
and Infant Outcome," Birth Gazette 13:1,
1996.
Induction of labor leads
to cesarean sections, instrumental delivery and
shoulder dystocia
Maternal and neonatal outcomes after induction
of labor without an identified indication.
Am J Obstet Gynecol. 2000 Oct;183(4):986-94.
Dublin S, Lydon-Rochelle M, Kaplan RC, Watts DH,
Critchlow CW
Department of Epidemiology, University of Washington.
OBJECTIVE: This study was undertaken to examine
associations between induction of labor and maternal
and neonatal outcomes among women without an identified
indication for induction.
Study Design: This was a population-based cohort
study of 2886 women with induced labor and 9648
women with spontaneous labor who were delivered
at 37 to 41 weeks' gestation, all without identified
medical and obstetric indications for induction.
RESULTS: Among nulliparous women 19% of women
with induced labor versus 10% of those with spontaneous
labor underwent cesarean delivery (adjusted relative
risk, 1.77 ; 95% confidence interval, 1.50-2.08).
No association was seen in multiparous women (relative
risk, 1.07; 95% confidence interval, 0.81-1.39).
Among all women induction was associated with
modest increases in instrumental delivery (19%
vs 15%; relative risk, 1.20; 95% confidence interval,
1.09-1.32) and shoulder dystocia (3.0% vs 1.7%;
relative risk, 1.32; 95% confidence interval,
1.02-1.69).
CONCLUSION: Among women who lacked an identified
indication for induction of labor, induction was
associated with increased likelihood of cesarean
delivery for nulliparous but not multiparous women
and with modest increases in the risk of instrumental
delivery and shoulder dystocia for all women.
PMID: 11035351
Women having their first
babies (nulliparous- no previous births) are significantly
more likely to get sections when induced electively
(for no good medical reason)
Elective induction of labor as a risk factor
for cesarean delivery among low-risk women at
term.
Obstet Gynecol. 2000 Jun;95(6 Pt 1):917-22.
Maslow AS, Sweeny AL
Department of Clinical Outcomes and Quality Improvement,
Franciscan Health System, Tacoma, Washington,
USA.
OBJECTIVE: To determine the effects of elective
induction on the risk of cesarean delivery in
a cohort of women with low-risk term pregnancies
and to evaluate the costs of elective induction
services within our hospital system.
METHODS: Records of 1135 eligible women with
low-risk, singleton, vertex pregnancies at 38-41
weeks' gestation who were eligible for vaginal
delivery were analyzed retrospectively after elective
induction (n = 263) or spontaneous labor (n =
872). Outcome measures included cesarean delivery
and direct costs. Variables evaluated were parity,
maternal age, estimated gestational age, birth
weight, prior cesarean delivery, epidural anesthetic
use, and provider category. Analysis was by univariable
and multivariable regression modeling.
RESULTS: Elective induction placed nulliparas
at a twofold higher risk for cesarean delivery
(odds ratio 2.4, 95% confidence interval 1.2,
4.9) after adjustment for birth weight, maternal
age, and gestational age. We found a significantly
increased risk of cesarean delivery with increased
birth weight for nulliparas (2-66.7%). Increasing
maternal age increased the risk of cesarean delivery
in all parity groups (P<.05), but particularly
among nulliparas (3-26.3%) (P <.001).
Electively induced labors that ended in vaginal
delivery cost $273 more and required an average
of 4 hours more in the hospital before delivery
than did noninduced vaginal deliveries (P <.001).
CONCLUSION: Elective induction significantly
increased the risk of cesarean delivery for nulliparas,
and increased in-hospital predelivery time and
costs.
PMID: 10831992
Women having their first
babies are twice as likely to get sections when
labor is induced
Induction of labor and the relationship to
cesarean delivery: A review of 7001 consecutive
inductions.
Am J Obstet Gynecol. 1999 Mar;180(3 Pt 1):628-33.
Yeast JD, Jones A, Poskin M Saint Luke's Perinatal
Center, Saint Luke's Hospital of Kansas City,
Kansas City, Missouri 64111, USA.
OBJECTIVE: The goal of this project was to study
the increasing risk of induction of labor in a
community hospital and to determine whether it
had an adverse effect on the rate of cesarean
delivery.
Study Design: From January 1, 1990, through July
31, 1997, 18,055 consecutive singleton pregnancies
in women who were candidates for labor were reviewed
via a comprehensive perinatal database. The risk
of and indication for induction were reviewed.
Cesarean delivery rates were calculated for nulliparous
and multiparous patients by indication for induction
and were compared with rates for patients who
had spontaneous labor. Overall trends in cesarean
delivery were reviewed for the duration of the
study period.
RESULTS: The annual induction rate significantly
rose from 32% to 43% at the conclusion of the
study period. Labor was induced in nearly 40%
of nulliparous patients. Postdate pregnancy was
the most common indication for induction, although
few patients were at or beyond 42 weeks' gestation.
The cesarean delivery rate remained at or below
20% for the years of the study. No increase was
noted in spite of the increasing risk of induction.
However, for nulliparous patients who had elective
induction of labor, the risk of cesarean delivery
was twice that of nulliparous patients who had
spontaneous labor.
CONCLUSION: The use of induction methods has
significantly increased in this community hospital.
More than 40% of patients are now candidates for
induction. The cesarean delivery rate remains
low in this facility in spite of a marked increase
in risk of operative delivery for nulliparous
patients who undergo induction
Comment in: Am J Obstet Gynecol 1999 Nov;181(5
Pt 1):1273-4
PMID: 10076139, UI: 99176971
Induction and epidurals
lead to c-sections
Risk of cesarean delivery with elective induction
of labor at term in nulliparous women.
Obstet Gynecol. 1999 Oct;94(4):600-7.Seyb ST,
Berka RJ, Socol ML, Dooley SL
Department of Obstetrics and Gynecology, Northwestern
University Medical School, Northwestern Memorial
Hospital, Chicago, Illinois, USA.
OBJECTIVE: To quantify the risk of cesarean delivery
associated with elective induction of labor in
nulliparous women at term.
METHODS: We performed a cohort study on a major
urban obstetric service that serves predominantly
private obstetric practices. All term, nulliparous
women with vertex, singleton gestations who labored
during an 8-month period (n = 1561) were divided
into three groups: spontaneous labor, elective
induction, and medical induction. The risk of
cesarean delivery in the induction groups was
determined using stepwise logistic regression
to control for potential confounding factors.
RESULTS: Women experiencing spontaneous labor
had a 7.8% cesarean delivery rate, whereas women
undergoing elective labor induction had a 17.5%
cesarean delivery rate (adjusted odds ratio [OR]
1.89; 95% confidence interval [CI] 1.12, 3.18)
and women undergoing medically indicated labor
induction had a 17.7% cesarean delivery rate (OR
1.69; 95% CI 1.13, 2.54). Other variables that
remained significant risk factors for cesarean
delivery in the model included: epidural placement
at less than 4 cm dilatation (OR 4.66; 95% CI
2.25, 9.66), epidural placement after 4 cm dilatation
(OR 2.18; 95% CI 1.06, 4.48), chorioamnionitis
(OR 4.61; 95% CI 2.89, 7.35), birth weight greater
than 4000 g (OR 2.59; 95% CI 1.69, 3.97), maternal
body mass index greater than 26 kg/m2 (OR 2.36;
95% CI 1.61, 3.47), Asian race (OR 2.35; 95% CI
1.04, 5.34), and magnesium sulfate use (OR 2.18;
95% CI 1.04, 4.55).
CONCLUSION: Elective induction of labor is associated
with a significantly increased risk of cesarean
delivery in nulliparous women. Avoiding labor
induction in settings of unproved benefit may
aid efforts to reduce the primary cesarean delivery
rate.
PMID: 10511367, UI: 99439385
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