Q&A: Labor InductionApril C. Sanchez, M.D.
QCan you give me your opinion on trying to induce labor for 8 continuous days using pitocin. Labor had not started on its own.
A Induction of labor using pitocin is a relatively common practice. Pitocin is actually the same thing as oxytocin, which is a hormone that is naturally produced in the pituitary (a small gland in the brain). At the beginning of the twentieth century, oxytocin was found to stimulate contractions in a near-term uterus. Since then, it has been safely used in the induction and augmentation of labor in full-term pregnancies. To induce labor is to stimulate labor from the beginning. To augment labor is to make the contractions stronger or closer together in a labor which is not progressing adequately.
Induction of labor at or near term (a pregnancy greater than 39 weeks) is often done for convenience. Sometimes it is easier for the patient and her family to be able to make plans when they have a specific date scheduled for delivery. This can be safely done when the cervix is "ripe". A ripe cervix is one that is soft and starting to dilate and efface (thin). Also, with ripening, the cervix moves from a posterior position at the back of the woman's vagina to a more anterior, or front, position. If the cervix is not ripe, it is usually not a good idea to induce without a good medical indication because it can be difficult to acheive a good labor pattern.
Induction of labor is often done for several indications which include blood pressure problems, growth problems with the baby, inadequate fluid around the baby, or post-dates (a pregnancy greater than 42 weeks). In these circumstances, the baby must be delivered, regardless of whether the cervix is ripe or not. There are several agents which can be used to promote cervical ripening. These include prostaglandins, which are available in oral or vaginal preparations. Also, ripening can be accomplished by inserting laminaria into the cervix, which expands with time and manually dilates the cervix. These preparations are often used in conjuction with a serial pitocin induction, meaning several days of pitocin, with rest periods or ripening overnight. Amniotomy (breaking the water bag) can often help to speed labor, but this commits you to delivery. Once amniotomy is performed, active labor should begin within 18-20 hours. It is unusual to continue an induction for more than 2 or 3 days. If delivery can be safely delayed for a week or greater, there probably was not a very compelling medical reason to induce in the first place.
April C. Sanchez, M.D.
Click here to Ask Dr. Sanchez your pregnancy questions.
Dr Sanchez lives with her husband and two boys ages 6 and 2 in Mandeville, Louisinana. She is a Board Certified OBGYN with a dregree from Louisiana State University Medical School. She completed her residency through the Tulane University Medical School Residency Program. She also received a Surgical Excellence Award.
Total Woman Care
She is now practicing Obstetrics and Gynecology at Total Woman Care, in Manderville, Louisiana. The Total Woman Care website, (http://www.totalwomancare.com) is an "Advanced" Obstetrics and Gynecology Practice that cares and provides for the needs of women with total Compassion, Empathy, and Understanding. Dedicated to Provide Obstetrics and Gynecology Related Information for the Women of West St Tammany Parish.
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