“Induction is sometimes necessary and life saving. Other times it is just a routine part of a crazy trend.” Pam England, author of Ancient Map for Modern Birth.
An induction of labour may be sought for different reasons. In general there are medical reasons for artificially starting labour such as a last resort if baby is overdue and no signs of labour are visible. There may be a health concern for either the baby, the mother or pregnant person. Occasionally there may be social or even personal reasons to want an induction at a certain date. Whatever the reason for an induction, it is always important to understand what this intervention is and how it may affect you and your baby.
We know from research that baby initiates labour by releasing a hormone that is uptaken into the parental body and causes contractions to start. This usually means that your baby is ready to be born. This can occur at any stage whereby your baby is considered full term, from approximately 37-42 weeks. But what is the process by which the body gets ready to go into labour and why is an induced birth so different from a spontaneous one?
Let’s take a look at the primary hormone involved in starting labour. Oxytocin is one of the hormones produced by your body. It is an extraordinary hormone that is vital and integral to our survival in a way. It is the hormone responsible for bonding, and it enables us to form attachments to other people. We produce oxytocin when we are in company with friends, enjoying time together and feeling good. It is released when we hug, laugh, feel good or make love. It is also needed for any ejection reflex such as orgasm, sperm, milk and fetal ejections. It can be thought of as the L hormone for it is present in love, lust and labour after all.
This hormone, however, requires certain things to be in place for its release. We need adequate receptor sites in the body and on the uterus for it to work its magic. The more receptor site our bodies have the more efficiently the oxytocin will work in our system and when labour begins, the more effectively the uterus will contract.
There is a difference between the body’s own manufacturing of oxytocin and artificial oxytocin given when an induction of labour is planned. There is a difference in how the body utilises the hormone and how it reacts to it. The brain also plays an important role in how it uptakes and responds to the hormone. Our bodies, our babies and our births, all are affected by the type of oxytocin that is flowing in the body.
Differences in how natural and artificial oxytocin work.
Natural oxytocin is released by our body spontaneously. It is produced in the hypothalamus and release by the pituitary gland. It is released into the bloodstream and moves to the site where it is needed. At the end of pregnancy it concentrates in the uterus to create contractions and it works by acting as a key to unlock oxytocin receptors in the uterus. When the pregnancy has reach full term the receptors in the womb have increased and when labour contractions start, these receptors help release additional oxytocin into the bloodstream and the uterus contracts aiding the cervix to dilate. It also acts in the brain to bring about calmness and relief from pain.
Natural oxytocin is released in a pulsating action and comes in waves which increase over time, carrying you forward towards the birth of your baby. The incredible way natural oxytocin works is to allow the body to adapt and to rest in between each contraction therefore creating natural rest periods before increased activity begins with the active phase of labour.
Synthetic oxytocin, on the other hand, is a chemically created compound that mimics the natural hormone but it does not behave in the same way in the body and brain. First of all it does not produce the wave-like sensations of natural contractions therefore creating stronger, longer and more intense contractions than would be normal in the beginning of labour.
The use of artificial oxytocin is sometimes needed to initiated labour before the body or the baby are ready, and this in turn may mean that the body has not yet produced sufficient oxytocin receptors, so more synthetic oxytocin may be needed to get labour going. The synthetic oxytocin is given continuously and increased over time creating uniform contractions with no natural pattern and no breaks making it very difficult to carry on coping with the sensations without the use of additional pain relief. Many people during an induced labour may feel defeated when they cannot continue without the use of a pain-relieving drug. Just a reminder that this unnatural pattern is different from what the body creates and it is compassionate to use some form of pain relief during an induced birth.
A less known fact about artificial oxytocin is that it does not cross into the brain of the labouring person so it does not help ease stress or pain perception, contributing instead to the release of stress hormones which can counteract the progress of the labour. The stress hormone adrenaline is in direct opposition to the release of oxytocin during the first stage of labour, so more attention is needed to find ways to reduce stress than would otherwise be needed.
Differences in contraction sensations
Natural oxytocin stimulates the uterus to contract and therefore helps the cervix to dilate. As the cervix opens, your body’s own pain receptors send signals to the brain which then releases endorphins. These endorphins are your body’s own pain-killers and they act 10 times more powerfully than morphine which in turn counteracts the sensation of pain. An incredible fact about endorphins is that as oxytocin levels increase in your system more endorphins are released therefore helping you to continue coping with the intensity of labour as it progresses.
During a spontaneous labour we can expect it to begin slowly, gradually building up intensity and length, therefore giving body your time to adjust and cope with the varying sensations.
Synthetic oxytocin, as mentioned before, does not cross the blood-brain barrier therefore there is no signal to the brain to release endorphins and pain is felt more intensely. This means that the full force of the contractions is felt from the beginning of labour instead of a rising intensity that is cushioned by endorphin release. From the start of an induction contractions are intense, frequent and long and continue to build with no time to adjust to the onslaught.
More synthetic oxytocin is needed to continue stimulating the uterus leading to more intense pain felt over time and therefore the increased need for medicated pain relief during most inductions.
Differences in movement in labour
During the natural onset of labour, most pregnant people spontaneously seek positions and places that feel most comfortable such as being upright, walking, leaning forward, squatting, side lying etc. and darker, quieter and safe spaces. This adds to the progress of the labour and the natural continuation of labour.
As labour progresses some labouring people may want to use water as a pain relief option and so use either a shower or bath to receive the comfort they need through contractions.
Usually with synthetic oxytocin other interventions may be necessary to safeguard the wellbeing and health of the pregnant person and baby. Some of these may limit the freedom of movement and contribute to changes in the labour and even the ability of the baby to get into an optimal position for birth. We call this increased need for interventions a cascade of interventions because one intervention may require the need for additional one therefore leading the labouring person to receiving a host of procedures and practices they might have hoped to avoid.
More frequent monitoring of the baby may be necessary to determine how the baby is reacting to the intensity of the contractions. This can limit freedom of movement and positions often resulting is a back lying position which can increase pain and may lead to undue distress in the pregnant person and the baby. The induction drug is set up with an IV drip and the belly is strapped with a fetal/contraction monitor making it more difficult to move around freely or to wander very far from the bed. Water use may be limited or prohibited due to all the cords, leads and attachments.
Differences in fetal ejection reflex
In an undisturbed labour, where the pregnant person feels safe, protected and supported and where minimal to no interventions are utilized, we may notice a very startling effect occur around the time of pushing the baby out. As oxytocin has an ejection effect, it helps with getting your baby out. A spontaneous fetal ejection reflex (FER) occurs whereby a powerful and uncontrollable urge to push or bear down to ‘eject’ the baby is noticed. This urge requires no instruction from outside parties and is instinctual and impulsive.
This fetal ejection reflex occurs when oxytocin levels flood and reach a peak enabling the ejection reflex but it is a very delicate stage of the labour and is interrupted when bright lights are put on, sudden movements or noises occur and when the labouring person is forced out of their birthing bubble to talk and interact with staff or other people.
At the same time as the flood of oxytocin, adrenaline is release to provide energy and alertness to birth the baby. This is the only time adrenaline works synergistically with oxytocin. At any other time in the labour, adrenaline is counteractive to oxytocin and will diminish its properties.
Induced labours do not have a peak since it is a pump that is releasing a constant flow of artificial hormone and cannot be adjusted, the body reacts consistently to the effect of the synthetic oxytocin. A fetal ejection reflex will not be experienced with an induction or an epidural birth. The signal to the brain, as mentioned earlier, is interrupted and therefore the instinct is waylaid.
During the final stages of an induced birth, some people may require additional interventions, such as instruments or caesarean birth to help them birth their baby, due to the inability to push effectively or the lack of energy after a difficult labour.
Differences in baby’s brain
Natural oxytocin assists your baby to come into the world by crossing the placenta and entering the baby’s bloodstream and therefore brain. The oxytocin then acts as a ‘silencer’ to protect baby’s brain from damage that could occur due to oxygen deprivation. This helps to keep baby safe during the final stages of labour. The additional surge of maternal oxytocin also primes the baby to produce its own oxytocin getting baby ready to bond with parents once born.
Synthetic oxytocin on the other hand can interfere with the baby’s ability to produce its own hormone, therefore delaying the bonding process. Baby will still bond with parents but may need a little more time to do so over the next few days as the body begins producing more natural oxytocin. Some parents notice this delay and are worried about this but rest assured, our bodies know how to compensate, especially if we are prepared with how to increase bonding afterwards with more skin-to-skin and baby time together.
Baby is more likely to experience hypoxia (oxygen deprivation) during induced labour, especially during the pushing stage and may experience distress, which may be noticed by the baby’s heart rate not picking up sufficiently after a contraction. If this pattern continues a caesarean is then recommended to safely deliver baby.
Differences in 3rd stage of labour
After a natural labour the body experiences an oxytocin high, the highest it will ever peak at, to assist in several crucial events. First and possibly most importantly it facilitates bonding between parents and baby. Subsequently it helps contract the uterus to release the placenta and to shut down blood vessels, minimising postpartum bleeding. During this time the oxytocin is also signaling the breast tissue to initial a letdown reflex which begins the lactation journey.
During an induced labour the oxytocin high is not experienced as strongly or instinctively, causing some to feel like bonding was delayed.
The uterus can become tired from the strong contraction experienced for many hours and may not function efficiently to release the placenta requiring an extra dose of oxytocin to complete the 3rd stage and avoid a postpartum hemorrhage
How to help your body be ready for labour
An induced birth can still be a positive experience and there are many things that can be done to help you have this. It is important to understand the different options and suitability for labour induction. The potential risks as well as the benefits should be outlined clearly by your provider and before any decision is made to assess your personal suitability against the Bishop’s Score (check the diagram below).
Get yourself savvy birth support, whether your partner is well informed or you both decide on adding a professional doula to your team, get the support you need to get through the birth. Attending a birth preparation course will also help you prepare in the best way possible.
Your environment is equally important so make sure you have low lighting, some mood music, privacy as well as feeling safe. Bring some led candles or string lights and some personal items that help you to create a more comfortable and home-like environment in the room.
Being mentally prepared before the birth and having a plan of action ready to get through it can make all the difference to your overall experience. An induced birth may be more intense but with some additional breathing techniques, the use of a labour TENS machine, some acupressure, warm compresses, massage, and positions changes, you will be surprised how much further you can go therefore increasing your own satisfaction in the process.
Other important aspects of preparing are to have a flexible birth plan or birth intention list and to do the next best thing that may be necessary to continue having a good induction. If things are not progressing the way you hoped they would, having the ability to shift and adapt to the changes can greatly enhance your perception of the experience. Having a frank discussion beforehand of your options for pain relief and other assisting factors can make you feel more in control and part of the decision-making process instead of feeling subjected to unwanted interventions.
Even if you are slightly impeded by the wires and the equipment, continue to use different positions to help you stay actively involved in your birth. Different birth positions may include side-lying with a peanut ball between your knees during rest periods, squatting, kneeling, leaning forward, and standing. Also ask for a wireless fetal monitor to minimise the number of wires leading from your person to stationary equipment. The more you move your body, the better it is able to progress and assist your baby to move downwards.
Finally prepare before birth to protect the golden first hour after birth. This is where you will want immediate skin-to-skin with your baby. You can see and smell as well as touch your baby. This time is also used to help initiate early chest/breastfeeding. Preparing beforehand with instructions to enhance this time after birth will continue to help you find more satisfaction in your birth even if an induction or other medical interventions are necessary.
Whatever the reason for an induction, how you prepare and confront it will play a huge role in your overall birth satisfaction.