Sunday, October 9, 2011

Bishop Score, Inductions, and C- Sections

These days, you can not talk to a group of women about labor without someone mentioning induction. Most of the time, women will say that their bodies "never went into labor on it's own." Sometimes, it will be a suspected large baby. For others, it will be that their fluid was a bit low. Maybe it is for convenience because a doctor is going out of town. Maybe the mom was just "done" with pregnancy. Whatever the reason, inductions are occurring far too often in perfectly healthy women with perfectly healthy uteruses. Most women (once me included) have no clue that there are serious risks to being induced. They may think that Pitocin is the "same thing" your body will produce. After all, if there were no risks, why not know the day your will meet your little one? Why "deal" with pregnancy for a possible week or two past your "due date"?
Intermountain Healthcare in Utah is one of the first hospital groups to stop allowing elective inductions prior to 39 weeks(I wish it was till 41 though). Because of this change in policy, they have seen a dramatic decrease in their c-section rates. I was recently looking at their website and found some information that they had on inductions. Here is what they say about inductions including some graphs.

Expert guidelines:
The American College of Obstetricians and Gynecologists (ACOG) is a professional organization for doctors who deliver babies. The following guidelines are based on advice from this organization. Your healthcare provider uses these guidelines to make a safe decision about whether or not an elective induction is right for you and your baby. If you don’t meet these guidelines, your healthcare provider may recommend letting labor take its natural course.
Before inducing labor:
Your healthcare provider must confirm that you have not previously had a cesarean delivery (C-section) or major surgery on your uterus.
Your healthcare provider must be certain of your due date to prevent starting labor too early, before your baby is fully developed.
You must be at least 39 weeks along in your pregnancy.
Your cervix must be soft and ready to open (dilate). Your provider can tell this by examining your cervix to determine a
Bishop Score, which is the standard measure for assessing the cervix’s readiness for labor. A Bishop Score of at least 10(some studies say 8) for first-time moms (8(6) for others) is a common threshold. With this score, the likelihood of having a vaginal delivery after induction is similar to that of spontaneous labor. See the graphs below to see how Bishop Score relates to length of labor and C-section rate.

When labor is electively induced before 39 weeks of pregnancy:
Your baby is 2 to 3 times more likely to be admitted to intensive care. This will mean a longer and more difficult hospital stay for your baby. It may also make it harder for the two of you to breastfeed or bond.
Your baby may have trouble breathing and need to be connected to a breathing machine (ventilator) to help her breathe.
Your baby may have trouble maintaining body temperature and need to spend time in a warming area (incubator) to keep her body temperature stable.

As you can see, there IS a correlation between inductions and c-sections...especially if the induction is done with a mom having a low bishop score. I can't tell you how many times I have known people who have been induced when they told me they are not yet dilated and their cervix is only 70-80% and the baby is still high in the pelvis. I always wonder if their care provider attempted to attain a favorable bishop score before encouraging the induction.

Here is the problem, if the mom's body is not ready (esp. in a 1st time mom) , it has the potential to lead straight to surgery. If the mom's body is not ready, the cervix may take a while to soften and dilate...this may take longer than a doctor is willing to wait. The baby may also not be in a good position for the descent that it is being forced to do and may not come down. Before you know, the mom is being told that either her pelvis is too small or that her baby is too big and they perform surgery for the birth to occur.

Another scenario that occurs is that the baby does not tolerate the pitocin (which causes stronger and longer contractions) well. The baby's heart rate may dip too low because of the stress and before you know, you have an emergency c-section.

I had pitocin with my first birth. My water had broken but I went straight to the hospital and they immediately put me on pitocin. I did not get to experience my contractions starting on their own; they would have. My first experience with labor was with pitocin..I HATED IT. I got an epidural as soon as I could. Now having experienced early labor for 2 births, I can tell moms the difference. When labor begins on it's own, it is a warm, mild tightening feeling that gradually grows in intensity. You ease into it. It makes labor much nicer in my opinion.

My biggest letdown about inductions(unless truly medically necessary of course) is how undermining it is. Yes, I am sharing MY opinion because you all want to know what it is;-) After all, you came to my blog.

I personally feel that it undermines the woman's body, the baby's readiness to be born, and God, who designed our bodies to work the way they do. To hear a woman say that her body never would have gone into labor makes me sad. Does she believe her body is broken? I hope not. Maybe her body needed 1 more day, or 2, or maybe even a week. I can't tell anyone an exact statistic but I am sure that in the history of man, most women are physically able to go into labor. You may think your baby is ready but maybe your body "cooks" babies a little longer. Here I thought during my last pregnancy that I was 41 weeks pregnant and when my midwife did the newborn evaluation, she told me that Sophia looked more like a 39 week baby.

I remember going to a birth a year ago and the mother's water had broken at 9:30pm. When her contractions started a few hours later, I found myself teary. Why? Because it was almost healing for me to see that it really does work. That my contractions would have started on their own when I was having Bella. I personally believe that the God that made me is a genius. I can not look at how perfectly our bodies are designed and not see divinity. It is amazing how babies grow into these people from a group of cells. Lactation fascinates me. When babies are induced without a medical reason, it is a little like a slap in the face. Mothers are also missing out on seeing how their bodies work.

We seem to be a society that wants everything convenient. We want our food to come fast. We want our Internet fast. We want to have marriages without working on them. We want births to happen when we want them to.

There you have my thoughts as of lately on inductions.


Laura: The Sushi Snob said...

I know a few women here in Utah County who are somewhat outraged that Intermountain Healthcare made that rule. It seems like most women around here just want to be induced, so they can plan everything. I guess I can understand the sentiment, but what about the baby? Don't they deserve to come on their own time if they're healthy?

Adria said...

I appreciate your comments on the topic. When I was pregnant 3 years ago an acquaintance in Utah told me that the trick to getting induced is to just lie from the day you begin seeing your doctor about when your last period was--just tell them it was two weeks sooner than it was and you'll get that induction you want! I think it's so sad that there are so many women out there who sound like they are scared or inconvenienced by childbirth. I think it's the most amazing thing that women are capable of and should be viewed as a near sacred experience.

Emily Gibbons said...

As always, Sarah, you make me think. :) It's nice to have so much valuable information at my fingertips from the fingertips of such a good friend. :)

Joanna said...

In response to Adria, my sister's friend takes it in the opposite direction: she lies and tells her doctor her last period was a week AFTER it actually was, so she won't get pressured to have her baby before her body is ready!

I can't tell you how wonderful it was to go into labor with Eve on my own, and the best part about it was the knowledge that my body COULD do this by itself. It was an incredibly emotional, spiritual experience for me.

Brooke said...

i'm not a big fan of being induced. it seems most doctors out here in wisconsin will NOT induce you until you are at least 40 weeks and dialted to a 3, which i really think is so smart. my sister was one of those who was induced early, her baby's heart rate dropped and she had an emergency c-section. she hated it!
anyway-i agree with you sarah. it's not smart to push those little ones out too early.