Sunday, January 3, 2010

Induction and perception

You all know how I feel about induction. Pinky has just posted about how tough inductions can be:

Like most L&D nurses, I hate to induce a primip with a long thick and closed cervix. Especially when she is not 42 weeks. Some babies go 42 weeks. We hate to see the 3 day induction. Which goes like this: 1st evening you get cervadil. Next morning we start pitocin even if you are still not ripe. Repeat cervadil in evening or maybe put in misoprostal next morning repeat pitocin. We might turn the pitocin off a few times if the floor gets busy during the day so you get set back a few times. By the 3rd day the woman and her partner are begging for a C-section. We hate to do this. Sometimes she pops into labor and delivers a baby no problem. But that is usually if she has a ripe cervix in the 1st place or by the end of 12 hours of cervadil. ...

Funny thing is no matter how much you tell folks about how the 3 day induction will suck, most will sign up for it. They must think, "Oh I won't be the 3 day induction and if I am I will get a c-section." I think most people down play the risk of c-section. Either they down play it or the catastrophize it. In my book a c-section is to be avoided if possible. It really is a big surgery but not a catastrophe. Most abdominal surgeries can be done by laproscopy. We have not figured out the laproscopic c-section.

It got me thinking about a blog I was following recently. Sometimes my google alerts kick up blogs of expecting moms and I end up scanning through them. This woman decided on an induction at 41+2 and wrote "I know I know, there are a lot of people out there that are against inducing, but [husband] and I are not." There are many ways the story could unspool, but the way it ended up was an induction beginning Sunday night, lasting through Monday night, and ending with a c-section on Tuesday morning due to exhaustion and slow progress. So, pretty consistent with Pinky's description.

This woman seemed OK with having ended up with a c-section, and I think it's great that she felt happy about her experience. But to me, it was illustrative of how choices with real consequences can start being treated as philosophic differences. I'm sure I would be placed into the class of one of the "lot of people out there" against inducing, but I am not "for" or "against" induction. Rather, I think that induction, particularly used electively and/or when the body is not ready (as measured by a Bishop's score), carries risks and that individuals should be aware of these risks.

Making the choice to use or not use an intervention involves a set of risks and benefits that every individual has to weigh for themselves. And one of the risks of induction is that it will be long, exhausting, slow, and result in a c-section which, as Pinky points out, carries real risk of its own. That's easy to ignore, though, when the discourse becomes whether people are "for" or "against" epidurals, inductions, c-sections, etc. That obscures the reality that these are not "chocolate or vanilla" choices of personal preference. It makes it easy to ignore the 3-day inductions and c-section complications, or at least to perceive them as common outcomes of labor (and so not consequences of the induction) vs. common outcomes of induced labor. It's hard because I think many people are trying to spread the word about the risks of induction. But if it's coming across as another "pick your flavor" choice, it's obviously not coming across correctly.


Anonymous said...

Thanks for this post, and for linking to Pinky's.

I have been posting about this a lot recently, here especially. I just was a doula for a 4 day primip induction at 39 weeks. Argh.

Rebecca said...

Argh, the long inductions. I think that because nurses and doulas get to see them the closest, they hate inductions the most. Four day inductions = The Worst.

massagedoula said...

I was induced with my 2nd son 11yrs ago. at 38 weeks because I had been experiencing "false labor" symptoms for several weeks following the death of a close relative.
This was before I became a massage therapist and doula, so I was doing what I knew at the time.
I was given a 1/2 pill, which apparently was cytotec on a Saturday night, the other 1/2 early Sunday morning followed by Pitocin. I pushed him out in 5 min. on Sunday evening.
With the knowledge and experience that I now have, I am extremely grateful that everything went well and he is healthy. However, if I knew then what I know now, I don't believe that I would have accepted the risks associated with induction.
This is an excellent post that shows what can happen, and does happen to many, many women who choose induction.

Mama to Monkeys said...

You know what freaks me out the most about those 3 day inductions? The risk of bleeding out post birth. If the uterus is *so* tired that I cannot contract effectively anymore or the oxytocin receptors in the brain are depleted, how on earth is the mother's uterus going to contract after the birth--likely surgical--if it has been forced into overdrive for three full days.

I have a feeling that as this becomes more and more of an issue that we are going to start hearing aobut more more maternal mortality and morbidity due to uncontrolled bleeding.

Then again, maybe not. Most women will likely praise the heavens that they were in the hospital in the first place so that the "emergency" was well handled.