Labor Induction and Birth Injuries

Birth injuries to mothers and babies can be avoided by up to 50% with proper planning and better care, based on the National Partnership for Women & Families (NPWF) research. If injuries happen, the medical team, including the doctor, may be held responsible for labor and delivery complications that affect the mother and the baby’s health. At times like these, some physicians may schedule a delivery to induce labor and avoid further complications.

The NPWF identified three situations that can occur at the end of pregnancy when women or newborns are likely to benefit from induction:

Prelabor rupture of membranes (broken water) after 37 weeks.
A pregnancy that has lasted more than 41 weeks.
High blood pressure at full term.

Labor induction carries added risks to both the mother and the baby, especially when not medically necessary, and can lead to an irreversible birth injury. These risks may include:

Failed induction: Around 25% of pregnant moms will start the induction with an unripened cervix and may need an emergency C-section when labor stalls.
Low Heart rate: The medications used to induce labor such as oxytocin or other prostaglandins can cause abnormal or excessive contractions that can diminish a baby’s oxygen supply and lower the heart rate.
Infection: Labor induction methods can increase infection risk for both the mother and baby. It happens when there is rupturing in the mother’s membranes.
Uterine Rupture: A rare but severe complication in which the mother’s uterus tears open along the scar line from a prior C-section or major uterine surgery. Emergency C-sections might be needed to prevent life-threatening complications and possible removal of the uterus.
Postpartum Hemorrhage: Labor induction can increase the risk for a mother’s uterine muscle not to contract correctly after giving birth (uterine atony). It can lead to severe bleeding after delivery.

In addition, newborn intensive care unit admission rates are higher when induction is present than mothers who experience spontaneous labor.

Birth Inducing Drug and Its Side Effects

When a mother finally gives birth, her body starts to release a unique hormone called oxytocin. The oxytocin triggers contraction of the uterine muscle that fuels the process of labor and delivery.

The most common synthetic drug made by reproducing oxytocin hormone is called Pitocin (and Syntocinon). Doctors use Pitocin to induce pregnant mothers to start labor as it stimulates uterus contractions to accelerate labor and delivery. Pitocin is widely used in labor and delivery rooms and is highly effective when used responsibly. However, it can also result in overstimulation and fetal distress that increases the risk of birth injury.

Pitocin is not a harmful drug but can be dangerous if not used properly as it can have a damaging side effect. Attentive obstetricians and delivery nurses can manage the side effects.

What is Pitocin?

Pitocin is an artificial form of oxytocin that helps women during childbirth. Oxytocin is a hormone released by the pituitary gland and serves a critical function in the childbirth process. The oxytocin stimulates the muscles of the uterus to contract and start the process of child labor. It continues to fuel the labor and delivery process prompting the body to release prostaglandins that further increase uterine contractions’ frequency and intensity. Pitocin is administered intravenously to stimulate the contractions.

The Pitocin is quickly absorbed into the bloodstream and triggers the biological reaction in the mother’s womb as how oxytocin would do. The Pitocin binds to the receptors on the uterus and activates the woman’s uterine muscles to facilitate contractions.

An OB-GYN would use Pitocin for one of two reasons:

To induce the start of labor when the baby is overdue.
To stimulate contractions and jump-start labor that is not progressing fast enough.

Side Effects of Pitocin

Pitocin is quite helpful in inducing childbirth. Like all other medications, it also has underlying side effects that increase the risk of birth injuries and other adverse effects during delivery.

The two underlying issues with Pitocin are:

Dosage Response.
Hyperstimulation.

To administer the proper amount of Pitocin is problematic because the drug’s effect on women can vary. There are women who tend to over-respond to the medication when receiving Pitocin. Then they will start to have overly strong and frequent contractions. Other women may experience little to no effect with the same dose of Pitocin.

This problem also affects doctors because they have no natural way of measuring the effects of Pitocin. Another complication is the delayed reaction time to Pitocin as the medication takes effect after 30 to 45 minutes after being administered. As a result, the second dose of Pitocin is given before the effects of the initial amount can be fully assessed.

Another issue with Pitocin is the potentially dangerous side effect known as hyperstimulation. When there is an overdose of oxytocin or the woman over-responds, there is a possibility of hyperstimulation of the uterus muscles. This type of overstimulation can trigger contractions that can be too powerful, too frequent, or too long to overstress the placenta and threaten the health of the baby.

The induction can happen eventually and put the patient into labor, and labor can cause contractions. The contraction can affect the blood flow and the oxygen delivered to the placenta. The placenta is the organ that develops inside the womb and attaches to the wall of the uterus. It is responsible for providing oxygen and nutrients from the mother to the baby until it is born and starts breathing independently.

Each time the uterine contractions occur during labor, the placenta gets compressed, and blood flow to the baby is restricted until the contraction subsides. This gives enough time to rest between contractions as it allows the baby to get oxygen before the next contraction.

If there is any compromise in the blood flow of oxygen to the fetus, the contraction will worsen the problem and leave the baby in need of critical oxygen.

The hyperstimulation from Pitocin can lead to intense contractions with short rest time in between. It can critically impair the functionality of the placenta during labor and limit the oxygen delivered to the baby. Oxygen deprivation during childbirth can be extremely dangerous and often the cause of neurologic birth injuries that can result in permanent disabilities such as cerebral palsy.

Guidelines in Using Pitocin

Pitocin’s inherent danger has led to the development of strict medical guidelines for the appropriate use of the drug. The guidelines give instructions on how the Pitocin should be administered conservatively, starting at a low dose with careful fetal stress monitoring. Once the contraction starts reaching a regular pattern, doctors should stop the administration of Pitocin. If labor is not progressing even after the Pitocin has triggered regular contractions, doctors should resort to C-section delivery and no more Pitocin.

Labor induction does not entirely lead to birth injuries. Birth injuries using labor induction will happen only if there is improper administration of the medicine. But with the constant monitoring of the obstetrician and delivery nurses, along with correct medicine administration, birth injuries can be prevented along with other side effects of induced labor.