The Risks of Inducing

Any medical intervention has benefits and risks.  The same goes for the drugs used to induce labor.  According to ACOG, inducing labor can be complicated by:

  • A change in the fetal heart rate
  • An increased risk of infection in the mother and the baby
  • Problems with the umbilical cord
  • An overstimulation of the uterus (strong contractions with few or no breaks in between)
  • A rupture of the uterus

The makers of Pitocin report rare but severe adverse reactions in some mothers who used Pitocin:

  • Anaphylactic reaction
  • Postpartum hemorrhage
  • Cardiac arrhythmia
  • Nausea
  • Vomiting
  • Hypertensive episodes
  • Rupture of the uterus
  • Excessive dosage or hypersensitivity to the drug may result in uterine hypertonicity, spasm, tetanic
  • Severe water intoxication with convulsions and coma has occurred, associated with a slow oxytocin infusion over a 24-hour period.
  • Maternal death due to oxytocin-induced water intoxication has been reported.

They also report the following adverse reactions in the fetus or newborn:

  • Bradycardia
  • Premature ventricular contractions
  • Permanent CNS or brain damage
  • Fetal death
  • Neonatal seizures have been reported with the use of Pitocin
  • Low Apgar scores at five minutes
  • Neonatal jaundice
  • Neonatal retinal hemorrhage

One of a woman’s greatest assets in labor is the ability to move around, change positions, walk, rock, squat, lunge, shower and bathe.  Once a labor-inducing medication is introduced, it can restrict her mobility.  That’s because medical guidelines call for the continuous monitoring of the baby’s heart rate and the mother’s contractions.  Those monitors are placed on the mother’s belly and are connected to equipment next to the mom’s bed, meaning that she can’t travel too far from the bed or the monitors.

Two other downsides to having a drug-induced labor:  pain and cesareans.  When labor is induced, the contractions can come on very strong, prompting the mom to understandably opt for an epidural to relieve the pain.  In some cases, a laboring mother’s chances for a cesarean increase after an epidural.

The last downside to being induced has to do with the method of induction.  The two drugs discussed so far, Pitocin and Cervidil, were created for and have been approved by the Food and Drug Administration (FDA) as labor-inducing drugs.  A third commonly-used drug, Cytotec, was not developed nor has it been approved by the FDA, for use as a labor-inducing drug, yet it us used routinely to induce labor for over a decade despite evidence that it can cause and has caused severe complications, including death, when it is used in this off-label way.

In 2000, the head of the Searle, who manufactured Cytotec at that time, sent a letter to medical professionals to let them know that Cytotec should not be used as a labor inducing drug.  Yet, despite the company’s warnings and letters to the FDA from medical professionals opposing its use as a labor-inducing drug, it continues to be widely used by obstetricians and midwives because of its low cost and its effectiveness in inducing labor.

Pfizer’s own patient information insert warns against using Cytotec to induce labor:

Pfizer Patient Information: Cytotec

Labor and delivery: Cytotec can induce or augment uterine contractions. Vaginal administration of Cytotec, outside of its approved indication, has been used as a cervical ripening agent, for the induction of labor and for treatment of serious postpartum hemorrhage in the presence of uterine atony. A major adverse effect of the obstetrical use of Cytotec is the hyperstimulation of the uterus which may progress to uterine tetany withmarked impairment of uteroplacental blood flow, uterine rupture (requiring surgical repair, hysterectomy, and/or salpingo-oophorectomy), or amniotic fluid embolism. Pelvic pain, retained placenta, severe genital bleeding, shock, fetal bradycardia, and fetal and maternal death have been reported. There may be an increased risk of uterine tachysystole, uterine rupture, meconium passage, meconium staining of amniotic fluid, and Cesarean delivery due to uterine hyperstimulation with the use of higher doses of Cytotec, including the manufactured 100 mcg tablet. The risk of uterine rupture increases with advancing gestational ages and with prior uterine surgery, including Cesarean delivery. Grand multiparity also appears to be a risk factor for uterine rupture.  The effect of Cytotec on later growth, development, and functional maturation of the child when Cytotec is used for cervical ripening or induction of labor has not been established. Information on Cytotec’s effect on the need for forceps delivery or other intervention is unknown.

Excerpted from Pfizer’s Patient Information Insert about the drug Cytotec

If a caregiver suggests inducing with Cytotec, a mom should ask questions to understand why the provider wants to induce and what the risk is to the mother and the baby.  She should be sure to understand all of the potential risks and benefits before making a final decision.

Is Your Body Ready for Labor?

Why Not Induce Before 39 Weeks?

Drugs to Induce Labor

Non-Medical Ways to Start Labor