Induction of labour refers to “the process of triggering uterine contractions prior to the onset of spontaneous labour.” Induction of labour is regarded as successful if it leads to normal delivery of the baby. In the period between 1990 and 2009, the percentage of women in USA doubled with the rates of early term induction increasing from 2% to 8% in the same period . Despite claims that the induction of labour has adverse effects has on the mother and the foetus, the rise in women that undergo induced labour makes me interested in studying these effects. This essay shall commence by discussing methods used in the induction of labour, the common indications for and discuss the implications of the procedure on the foetus. The essay will argue that the adverse effects of induce labour outweigh the benefits.
Methods used in the induction of labour
Some of the negative effects of induction of labour are linked to the methods. The most common method used in the induction of labour involves the use of drugs (Fisch, Pedaline, & Brooks & Simhan, 2009). There are two drugs that are commonly used for the induction of labour include: Pitocin and prostaglandins.
Pitocin (a synthetic form of oxytocin) is administered intravenously and its sensitivity is dependent on gestational age and parity. Researchers have speculated that there is a link between autism and Pitocin. A study by Atterbury (2003) and another by Mozurkewich et al. ( 2009) found that Pitocin ends up in the system of the foetus resulting in disruption of the normal function of oxytocin. This disruption is linked to the social impairments that are seen in autistic children. On the contrary, Wennerholm, Hagberg, & Bergh (2009) established that the use of Pitocin in the induction of labour after 41 weeks reduces incidences of perinatal deaths. They further showed that up to 7 perinatal deaths occur if the pregnancy is allowed to progress for more than 41 weeks (Wennerholm et al., 2009). While this drug is systemic hence administered intravenously the prostaglandins act locally hence they are administered at the vagina. Pitocin’s action is mediated by impairment of the function of oxytocin while prostaglandins act causing the relaxation of the cervical muscles.
Two forms of prostaglandins that are available for use in the induction of labour: dinoprostone (PGE2) and misoprostol (PGE1). Dinoprostone is administered as a gel via the vagina and is used for the ripening of the cervix. Ripening of the cervix is attained through the relaxation of the cervical muscles resulting in the contraction of the uterine muscles. Misoprostol can also be used for the induction of labour. On the other hand King & Little (2010) reported that prostaglandins cause very rapid contractions which prevent the foetus from accessing the oxygen in the intervillous space because oxygen is not sufficiently replenished in between the short contractions intervals. This increases the risk of adverse effects on the foetal brain cells (King & Little, 2010).
Membrane sweeping and amniotomy (puncturing the uterine membranes to release the amniotic fluid) is also used in the induction of labour. This triggers the release of oxytocin from the posterior pituitary followed by the release of prostaglandins which result in the onset of contractions of the uterus. This procedure is recommended where the cervix favours natural labour. On the other hand Wennerholm et al. (2009) reported that amniotomy can harm the foetus if the head is too close when the amniotic fluid is punctured.
Common indications for labour induction
The inducement of labour is carried out in any of the following conditions: hypertension or preeclampsia, infection of the amniotic fluid, intra uterine foetal death, maternal medical complications and isoimmunisation. Research conducted by Fisch, Pedaline et al. (2009) to determine the effects of labour induction for pregnancy beyond the 41st weeks indicate that for every 369 women under this conditions, at least one case of neonatal death is prevented. The study also revealed that the induction of labour has fewer consequences on the foetus particularly the reduction of the risk of the foetus developing meconium aspiration syndrome. On the other hand Wennerholm et al. (2009) revealed that there is no direct link between perinatal death and induction of labour because deaths that occur due to post term pregnancy are remotely linked to the duration of the pregnancy. This study further indicates that the difference in mortality rates among women who induce labour and those who don’t is statistically insignificant (Wennerholm et al., 2009).
Some women develop hypertension during pregnancy and in some case protein could be present in the urine of the women. This can impair the flow of oxygen to the foetus therefore making it necessary to induce labour. Atterbury (2003) established that the induction of labour for women whose pregnancies are 36 weeks or more is likely to improve the maternal outcomes. On the contrary Wennerholm et al. (2009) found evidence to suggest that the induction of labour for such women has several negative impacts on the foetus such as low birth weight, jaundice and breathing problems (Wennerholm et al., 2009). In conclusion induction of labour does more harm than good to the foetus.
Consequences of labour induction to the foetus
The inducement of labour increases the chances of the baby being born prematurely (before sufficient development organ systems) because there is no accurate means of determining the exact due date of the baby. As a result, the baby may have difficulties in breathing because the lungs are underdeveloped, difficulties in eating and the maintenance of body temperature. Studies have however revealed that the induction of labour between weeks 41 and 42 might slightly lower the risk of meconium aspiration syndrome although the reduction of the risk is not statistically significant (Wennerholm et al., 2009).
The babies who are born as a result of inducement of labour have a higher chance of being admitted to the neonatal intensive care unit especially in instances when the foetus is not well developed at the time of birth. The admission of the baby to the neonatal intensive care unit prevents the mother and the child from bonding naturally through breastfeeding. However, a randomized study involving women who opted to undergo labour induction as a result of a complication and those who underwent elective labour induction revealed that elective induction reduced the risk of admitting the neonate to the intensive care unit to some extent.
Unfavourable positions that the baby assumes when labour is induced may necessitate the use of vacuum extraction and forceps for the removal of the foetus from the womb which may cause subgaleal haemorrhage . This is exhibited by the bogginess of the scalp, the expansion the circumference of the head, tachycardia, hypovolemia and a falling haematocrit. Intracranial haemorrhage may also occur in cases when forceps and vacuums are used in the delivery of the baby (Wennerholm et al., 2009). Other complications that are associated with retinal haemorrhage include: retinal haemorrhage and cephalohematoma (Mozurkewich et al., 2009).
Conclusion
The induction of labour may be a necessary medical procedure in certain instances such as when the mother suffers from hypertension, gestational diabetes or the foetus develops an infection. However, even in instances when it is necessary, induction of labour has negative consequences on the foetus. The available research accrued from different studies points out inefficacy and the harm of induction of labour. Induction of labour has been linked to the occurrence of autism, respiratory complications for the baby, interruption of oxygen supply to the foetus, foetal distress and the increased need for the neonate to be hospitalized in the intensive care unit (Mozurkewich et al., 2009). It is therefore necessary for the mother to be to fully understand the implications of induction of labour before undergoing the procedure. Research also ought to be carried out in order to find safer methods for carrying out the induction of labour.
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