Article by Sara Wickham, translated by Ekaterina Zhitomirskaya. Published in the magazine AIMS (AIMS - Alliance for the Improvement of Maternity Services - a British public organization "Union for the Improvement of Maternity Services") AIMS JOURNAL Vol: 26 No: 2 2014 6-8
In modern Western culture, most women are aware of induction of labor even before they become pregnant.
They know that stimulation is offered if it is believed that it will be safer for the baby to be born than to remain in the womb. I also suspect that many women know that one of the main reasons for giving stimulation is the gestational age after which the baby is considered "post-term." Also, many women know some other women who have been stimulated to labor, so they know other stated reasons for the stimulation. These reasons may be the woman's age, if it is above “normal”, and premature outpouring of water, and / or health problems, as well as complications of pregnancy, in which stimulation of labor may be necessary
But that's not all. There are many other aspects to the decision whether to agree or not to stimulate labor, which also makes sense to take into account. I have spent the last few months researching this topic. The result was the recent publication (revised and updated) of my book Inducing Labor: making informed decisions (AIMS, London). In May, for the presentation of this book in Bristol, I prepared a talk titled "10 Facts Every Woman Should Know About Inducing Labor." I was not going to dwell on things that are generally known (see above), instead I wanted to draw your attention to some facts, circumstances and assumptions that are less known and which, perhaps, make sense to take into account when we make a decision on stimulation. In fact, of course, there is a lot more worth knowing, so my list of ten facts is just a starting point for discussion, and not exhaustive information on the issue.
1. It doesn't look like a normal birth.
This is clear to some, but I know from experience that not to everyone. Induced labor is very different from labor that started spontaneously. Of course, each woman's personal experience of childbirth is different, but there are differences that are almost universal. First, a synthetic hormone is administered to a woman to induce labor, which causes more pain than spontaneous labor. And this pain comes faster. Synthetic hormones, unlike our own hormones, do not cause the release of painkillers into the bloodstream, which are produced by the female body during normal childbirth. In addition, stimulation can have its own side effects, which means that such a woman will be observed more closely. Such closer observation can lead to a limitation of the woman's mobility, which increases tension and, consequently, pain, and this, in turn, can make the woman feel that the situation is spiraling out of control.
2. It hurts
I started talking about this in point 1, but there are other sources of pain that I think women should be aware of before making a decision. For example, contractions caused by a prostaglandin gel or balloon, which is often used in the first stage of labor induction, can quickly become painful without any visible effect. This gives a negative experience of childbirth, in addition, in such a situation it is easy to get tired and / or lose your presence of mind much earlier than in the early stage of spontaneous childbirth. Oxytocin-induced contractions can also be very intense, and often the woman has less time to adapt to them than in spontaneous labor. More frequent vaginal examinations and other manipulations (for example, using a balloon) can cause additional pain.
3. "The service comes in a package"
I wrote a lot about this on my website (), so I won't repeat myself too much. But the fact that they keep asking me whether physiological management of the third period (placenta delivery) is possible, as well as the rejection of CTG and / or vaginal examination in case the labor was stimulated, makes me think that this is not a generally known fact. Not that someone wants to prevent a woman from making the right decision. But the drugs used to induce labor are powerful enough. They block the secretion of their own hormones, and this can cause problems for the woman and the child. And the effect of these drugs, stimulating labor, needs to be assessed, monitored and, if necessary, compensated. If a woman feels that these side effects of stimulation are not what she wants, then perhaps it is better to ask herself if this stimulation is needed at all.
4. Detachment of membranes is not so harmless
Nowadays, many places where it is customary, at some stage of pregnancy, to offer women to “peel off” or “manually separate” the membranes in the hope that this will reduce the number of women who need drug stimulation. Even if we ignore the assumption that all women who are offered stimulation will agree to it, we must understand that the separation of the membrane can cause discomfort, bleeding and irregular contractions, and according to the results of some studies, this procedure accelerates the onset of labor by only 24 hours ... The authors of the Cochrane review conclude: “Routine use of manual sheathing from 38 weeks onwards does not appear to provide significant clinical benefits. This manipulation to induce labor must be considered in conjunction with the woman's discomfort and other side effects of the procedure ”(Boulvain M, Stan CM, Irion O (2005) Membrane sweeping for induction of labor. Cohrane Database of Systematic Reviews 2005, Issue I. Art. No .: CD00451. DOI: 10.1002 / 14651858.CD000451.pub2).
5. "Natural stimulation" is an oxymoron
I also wrote about this elsewhere, and this article can be read on my website (Wickam S (2012) When is induction not induction? Essentially MIDRIS 3 (9): 50-51), but the main idea is easy to state: either we we are waiting for the natural start of labor, as it happens according to natural laws, or we are trying to intervene and cause labor before they would have started themselves. Sometimes there are good reasons to induce labor, but if a woman takes castor oil or asks her midwife to manually separate the membranes every day, or chooses some other “folk” method of stimulation, then she is going to induce her labor with non-drug means. Please note that I am not trying to say that something is wrong here, but I believe that since we live in a culture that devalues female bodily functions, it is important to be clear about what our intentions are.
6. This is NOT the law
While I was writing the book, I was amazed to learn that the AIMS hotline received a call from a woman whose midwife said, “We need to stimulate you 24 hours after the water drains. This is the law. ” This woman agreed to induce labor, which proved to be very traumatic for her. I want all women to know that there are no laws that define what a pregnant woman should or should not do. It worries me and AIMS very much. Any physician who claims this should be reported to the parent organization. Any woman who is threatened in any way, or simply states something similar, we ask to contact AIMS for information and other support.
7. It's not just a drop
I am always alarmed when I hear the words of midwives or doctors underestimate the recommended intervention. I especially dislike the expression "a drop" or "a little help" used in relation to intravenous drip of oxytocin. This is a powerful drug and should be treated like that. It can cause fetal distress, and in some clinics it is generally accepted to increase the dose of oxytocin until the child reacts with distress (!), And only then stop increasing the dose - it is believed that this is how the proper level of oxytocin is determined. But even when the dose of oxytocin is not increased, as soon as effective contractions are established, this drug should be treated with attention, and professionals should not underestimate its effect, whether intentionally or not.
8. The female body will not fail. Stimulation and System - Easily
The name speaks for itself. Stimulation does not always work, and the woman is not to blame for this. I would like to reassure all women whose labor has been unsuccessfully stimulated that everything is in order with them and with their bodies. This is another case where some of the expressions used in the rodblock are clearly worth revising.
9. The risks of overburdening come later, they are lower, and they are more difficult to prevent.
Below is the data that I use here and in the book. This is a generalization of the results of a study that examined the risk of stillbirth at different stages of pregnancy. If you look at the values - and I especially ask you to compare the risks
at 37 and 42 weeks of gestation - you will find that the increase in risk is not at all as early as many think, and that the increase in risk is not as strong as is often assumed. In fact, the outcome of labor in women who expected spontaneous labor to begin labor was so similar that in women who gave birth with stimulation, no single study comparing stimulated labor and spontaneous labor has demonstrated the benefits of stimulation. It was only when these studies were brought together that it was possible to notice small differences. However, the quality of one of the studies (the one that pushed the scales) leaves a lot to be desired. Based on this, I would like to ask if there is any real benefit from the current protocols offering stimulation of labor after 40, but before 42 weeks. The book says much more on this topic, including a complete overview of the literature on the topic.
Risk of stillbirth of unknown etiology
for a period of 35 weeks 1: 500
for a period of 36 weeks 1: 556
for a period of 37 weeks 1: 645
for a period of 38 weeks 1: 730
for a period of 39 weeks 1: 840
for a period of 40 weeks 1: 926
for 41 weeks 1: 826
for a period of 42 weeks 1: 769
for a period of 43 weeks 1: 633
Adapted from Cotzias CS, Paterson-Brown S, Fisk NM (1999) Prospective risk of unexplained stillbirth in singleton pregnancies at term population based analysis. BMJ 1999; 319: 287. doi: dx.doi.org/10.1136/bmj.319.7205.287
10. The risks for seniors are not as certain as it is commonly believed
The final point refers to the statement that as a woman's age increases, the risks increase and therefore their labor should be stimulated. Indeed, some studies suggest a correlation between increasing maternal age and increased incidence of certain complications, but there are several reasons to be wary of this finding. Older women are more often examined and more often subjected to various interventions, and this in itself can cause complications. “Older” women are more likely to have health problems, and it is difficult to say what causes complications - the woman's health condition or her age. The studies that dealt with this problem do not always separate one from the other, and those studies where this was done involved women who gave birth a long time ago, and who cannot be compared with today's women. Thus, in this area, there is an extremely lack of material, and modern research on this topic, unfortunately, has only led to the fact that more and more often they stimulate younger women and at an earlier date, so that women also do not really care about the results of such studies. benefits.
A day or two after my presentation, I asked some colleagues what facts they would list, and they offered many interesting points. These were not ten facts, but dozens and almost hundreds of things that we would like women to know about. But at least this is the beginning. You can find more information about this (and more) in the book Stimulating Labor: Making an Informed Decision, published by AIMS. At present, our goal is to convey this information to as many women as possible before they make the decision to stimulate.
Sara Wickham is a midwife, educator, author and researcher with an extensive and varied practice as well as obstetric education, research, articles and books.
Sarah currently organizes “Recipes for Normal Birth” seminars for midwives and other professionals working in obstetrics, writes books for AIMS, speaks at various seminars and conferences, consults a lot and writes a column twice a week on her website www.sarawickham.com. where you can read many of her articles. Her latest book is Stimulating Labor: Making an Informed Decision.
