Labor Induction

Sometimes it is necessary to give your unborn baby a little nudge and kick-start the labor. Typical reasons include complications (such as diabetes or decreased levels of amniotic fluid), medical emergencies (such as water breaking before the onset of contractions), or pregnancy duration in excess of 40 weeks. Rarely, it is also a matter of scheduling convenience, especially around major holidays or in cases when getting to the hospital in a timely manner might be a problem.

When my due date arrived and my cervix was still closed, my OB-GYN proposed commencing labor induction the following day.  Theoretically, a baby could continue to thrive in the womb for 42 weeks, but the data might be skewed by inaccurate estimation of the onset of a pregnancy, so it’s safest not to wait too much longer past the 40^th week, especially when the conception date is fairly accurate (as in in vitro procedures).

Initially I frowned at the idea of inducing labor, as I wanted to give birth naturally and medication-free. But could I be sure that my baby would continue to thrive for a few more days or even weeks? I had barely gained any weighed in the last month of pregnancy, so the baby probably wasn’t benefiting from staying in the womb any longer. So I decided to take my OB-GYN’s advice and scheduled labor induction for the following day.

I reported to the maternity ward in the morning and thought I’d be having the baby the same day. A nurse had warned me it would take a while, but I had interpreted this to mean something on the order of 10 hours or less. I had no idea I’d be in the hospital for three days before I finally gave birth.

My OB-GYN had already stripped my membranes, so now we just needed to get my cervix to dilate enough. (Overnight, I had barely reached 1 cm of dilation.) I was given a medication called Cervidil and was told to stay bedridden for 12 hours before the nurse checked my cervix again.

When those awfully long 12 hours passed, the nurse and I were disappointed to see no change in dilation. The doctor ordered another dose of the same medication, and I waited 12 more hours in bed. When the next check also showed no progress, the OB-GYN decided not to put me on a stronger medication but to try the same one yet again. This time we didn’t need to wait for 12 hours before we knew something was happening.

It was just after midnight when I was awoken by strong contractions. I timed the first few, and when I assured myself that they occurred in intervals of less than five minutes, I called the nurse. She examined me and said that I was 3 cm dilated. The goal was 10 cm.

To boost the contractions and increase the dilation, the nurse put me on an intravenous medication called Pitocin and asked me what my birthing plan was. I told her I wanted to experience every sensation of childbirth and didn’t plan to take any sort of painkillers. I had had a very painful natural miscarriage just prior to this pregnancy, and I hadn’t taken any painkillers then, so I knew I could withstand severe pain for at least seven hours.

When the eight hour of active labor struck, I was pretty sure I couldn’t bear the pain for much longer (or at least I didn’t see a good reason why I should). My contractions were getting stronger fast, and the pain was unbelievable. At the onset of each contraction, my entire body would curl and tense, and I felt as if hundred of nerve cells were dying each minute. Like so many first-time mothers before me, I had never experienced greater pain in my life.

The nurse assigned to me was busy with another patient, and it appeared the entire staff on the floor was similarly occupied—all at the same time. (I was later told there were 19 births in our hospital wing that evening.) I knew I wasn’t a priority since this was my first delivery and thus the process was expected to take comparatively long, yet I pressed the button for the nurse every few minutes just to remind the staff I was in pain [smiley face]. Still, I ended up waiting and wriggling in misery for what seemed like an eternity. By the time someone finally came to see me, my hair had nearly turned white (both from the intensity of the pain and from the length of the wait). Don’t get me wrong, though; the nurses were doing an outstanding job. It was just a matter of which patient was screaming louder [another smiley face].

Joking aside, labor proved to be tougher than I had anticipated. I heard that the woman in the next room had asked for an epidural immediately upon being admitted—it was her third childbirth, so she obviously knew what to expect—and I decided to follow her lead. You can’t imagine my horror as I was told that my OB-GYN did not allow her patients to be given an epidural until they’ve reached a dilation of at least 4 cm.

The nurse gave me the option of taking a narcotic to dull the pain. She explained that the only side effect was drowsiness of both me and the baby until the medication wears off (which would take about an hour and a half). I readily accepted this alternative but did not get much relief. The pain was slightly more tolerable, but only barely so.

It took another hour before my cervix was dilated 4 cm.  Once I got the epidural, though, the pain vanished momentarily, and I spent the next few hours blissfully resting. The bliss, however, was interrupted twice by aberrations in the baby’s heartbeat.

Abnormal fetal heart rate is one of the possible side effects of labor induction. Others include rupture of the uterus, severe bleeding of the mother, oxygen deprivation (of both mother and baby), and so on. It is also important to note that the contractions caused by the medications used in labor induction are stronger than the natural ones and could cause the baby to assume a position that isn’t optimal for delivery. As a result, the risk of resorting to forceps, vacuum, or cesarean section increases, and so does the probability that a baby might end up in the neonatal intensive care unit (NICU).

What happened in my case was that all of a sudden my cervix began to dilate fast (in great contrast to the slow dilation we witnessed over the previous two days), my water broke, and the baby got stuck in the birth canal when I attempted to push. Since my oxygen supply had diminished (a side effect of labor induction), the baby too wasn’t getting enough oxygen, and my OB-GYN quickly summoned a team from NICU. She then ended up performing a vacuum-assisted vaginal delivery, which took mere seconds and prevented the need for a cesarean section. Keep in mind, however, that the use of vacuum also isn’t risk-free. The baby could have had collarbone or skull fracture, or bleeding within the scalp.

Luckily, my baby was born with no such complications. The only consequences were a rather long tear in my perineum and the loss of more blood than I would have suffered otherwise. I recovered from these relatively quickly, or at least no slower than had I had a perfectly natural delivery. Thus, despite the long (roughly 18 hours), painful labor, all ended well, and the baby and I made it safely home two days later.

Bottom line: If labor hasn’t started naturally, the baby probably isn’t ready to be born. Unless there is a medical necessity for labor induction, avoid it. The convenience of scheduling it isn’t worth the risk of possible complications.