Lamaze Magazine 2008 - (Page 21) provider may insert a prostaglandin gel or a ballon-like catheter. In some cases, this action alone may be enough to stimulate labor; in others, Pitocin may also be used. 4. Pitocin. If your cervix is soft and pliable, your caregiver may recommend the synthetic hormone Pitocin to stimulate contractions. It is given through an IV drip, and the amount is increased every 15 to 30 minutes until contractions reach a strong pattern. Since Pitocin-induced contractions can be very intense, your baby will be closely monitored. And because Pitocin is an artificial hormone, it does not trigger pain-decreasing endorphin production. 5. Non-medical Methods. Your health-care provider may suggest one or more of the following to get labor started: acupuncture, homeopathy, nipple stimulation, sex or even herbs such as black and blue cohosh tinctures. Don’t try any of these unless you’ve discussed it with your health-care provider, and stay in close communication about your progress if you do. Why: The number of inductions in the United States has been on the rise, with a trend of allowing them for non-medical reasons: the desire to plan the baby’s birth date, to minimize end-of-pregnancy discomfort or in order to have a favorite health-care provider attend the birth. Many women are induced because their healthcare provider suspects the baby is large. According to the American College of Obstetricians and Gynecologists (ACOG), this is not a medical reason for induction. Studies show that the birth of a big baby is not affected by inducing versus letting labor begin on its own. Here are ACOG’s medical indications for induction: | The water bag breaks and labor does not begin; | Pregnancy has reached 42 weeks; | The mother’s blood pressure is high; | Maternal health problems (diabetes, lung disease, severe preeclampsia or toxemia) that can harm the baby; | An infection of the uterus; | The baby has stopped growing or there are problems with the placenta. Lower your risk: The last weeks of pregnancy can be tough – the uncertainty of when labor will start, plus the challenges of sleeping and getting comfortable. But unless there is a clear medical reason, it is far less complicated and far more healthy for you and your baby to let labor start on its own. If a medical concern does arise, spend as much time as possible with your health-care provider, weighing the benefits and risks of each induction method. EPISIOTOMY What: A surgical cut to the perineal skin and the muscle beneath it, between the vagina and the anus, during the pushing stage. The two types of cuts are midline (straight down toward the anus) or mediolateral (to the side). Why: If there is fetal distress, an episiotomy may shorten the pushing stage by 5 to 15 minutes so the baby can be born faster. It is often required if the baby needs to be assisted, rotated with forceps or a vacuum extractor, or if his shoulders aren’t able to rotate and pass through the pelvis. It is also used if the perineum is not stretching or, more rarely, if the mother had a prior deep episiotomy. Lower your risk: Recent studies have shown that episiotomies often provide no real benefit to the mother or newborn – and actually increase perineal trauma and postpartum pain. Make it known before labor begins that you would rather not have an episiotomy if it can be avoided. During late pregnancy, continue Kegel exercises to strengthen and elasticize your pelvic floor. This will decrease your need for an episiotomy and lessen the chance of tearing naturally. Choose labor positions, like squatting, that help speed the process; try not to hold your breath for extended periods; and follow your body’s cues, pushing when you feel the urge. Warm compresses or oil (as crowning begins) on your perineum may help with the pain. Educate yourself, communicate your preferences in advance and stay involved in all decisions related to labor and birth. Your choices will be critical to the health and safety of you and your baby. | Online: Read more at lamaze.org/magazine. Being informed about common interventions that might arise will enhance your ability to make crucial decisions. PHOTO: N. AUBRIER/AGEFOTOSTOCK LAMAZE MAGAZINE 2008 21 LAMAZE.ORG http://lamaze.org/magazine http://LAMAZE.ORG
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