> Induced parturition, the assessment of the risks

    the

  • Introduction
  • the

  • Generalità on the risks
  • the

  • Cos’è pregnancy, prolonged
  • the

  • Risks associated with the waiting
  • Procedure and risks of induced labor
  • the

  • Experience of childbirth
  • the

  • Alternatives between waiting and induction medical
  • the

  • Conclusions

Introduction

In Australia, 26% of births are induced. The reason più for the common induction is the “pregnancy, prolonged“.

there is an incredible amount; of children who are referred by the welcome and requires induction. I impantanerò in the concept of “expected date” and what is or is not accurate. I believe that the EDD (estimated date of delivery) is a concept that will stayà – è deeply rooted in our culture and in our healthcare system. This post is focalizzerà on the induction for pregnancy prolonged and complexity; risk.

Generalità sui rischi

I do Not particularly like the concept of “risk” connected to the birth. Provide support based on risk rather than on individual women brings any kind of risks. However, the concept of risk together “expected date” will stayà, and the women often want to know the risks.

The risk is a concept that is very personal and different women will consider different risks as important to them. Everything we do in life involves risk. Therefore, when considering whether to do X or Y there are no options without risk. What women can do is to choose the option with the risks that are more willing to deal with.

However, to be able to make a decision women need adequate information on the risks of each option. If a healthcare professional does not provide adequate information on the risks present can; to suffer the legal consequences.

The induction for pregnancy prolonged not is right or wrong if the choice is made by a woman that has understanding of all the options and risks. As a midwife I am “the woman” regardless of his choices. My job is to share information and support decisions – not to judge.

Cos’è pregnancy, prolonged

Before going further, let’s clarify some definitions:

    the

  • the Term (in a period of gestation normal and healthy): it goes from 37 to 42 weeks.
  • the

  • the Post date: the pregnancy is continued beyond the expected date determined e.g. è over the 40 weeks.
  • the

  • the Post: the pregnancy is continued beyond the term, e.g. 42 + weeks.

The definition of the World Organization of the Sanità “pregnancy, prolonged” is a pregnancy that is continued beyond 42 weeks post-term. Very few women make the experience of a pregnancy is prolonged.

The idea of a pregnancy and prolonged means that all we have in gestation our children for the same length of time. It seems that genetic differences may influence what is a gestational time of “normal” for a particular woman.

Morken, Melve and Skjaerven (2011) reported “a factor family linked to the occurrence of pregnancy, prolonged through the generations and both mother and father seem to contribute.” Then, if the women in your family have a gestation of 42 weeks, è possible that the same for you.

The baby and placenta signal to the mother’s body that baby is mature and ready to be born (Mendelson 2009) – this dà the beginning to the complex series of physical changes which lead in the process of childbirth. How much time it takes for each child to become mature è variable.

Risks associated with the expected

In theory, after the end of 42 weeks the placenta begins to close.

Non c’è evidence to support this notion and Sara Wickham makes a significant criticism of this theory if you ever attend his seminars. C’è also a good explanation of physiological of the development and aging of the placenta, which concludes that: “there is no logical reason to believe that the placenta, which is an organ of the fetus, should grow old as does not happen to other fetal organs…”.

I have seen signs of the closing of the placenta (i.e.; calcification) in placentas at 37 weeks and I have seen placentas, big hydrated and healthy at 43 weeks. C’è also the idea that the child will becomeà the very large and the skull is calcificherà making it difficult to birth. Again there is no evidence to support this theory and babies are very good at finding the ways of exit from the pelvis, an expandable of their mothers.

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concerns about The wait beyond 41 weeks of gestation is focused on the potential death of the baby (perinatal death).

A Cochrane review summarises the quantitative research by examining induction versus waiting to 41 weeks, and the più: “There have been fewer deaths of children when a policy of induction of parturition has been implemented after 41 completed weeks or beyond“. However, he continues by saying “….such deaths were rare with both the policies…the absolute risk is extremely small. Women should be counseled appropriately on the risk absolute and relative“.

hands Up all the women who have had a discussion with their healthcare provider about the risks of absolute and relative wait against induction… as I thought. The analysis also found fewer cases of cesarean section and the aspiration of the meconium-stained group induction, but no difference in admission to the NICU (Unità Neonatal Intensive care).

and Then, essentially on the basis of the available research, if you have the induction at 41 weeks your baby has less chanceà to die during or shortly after birth. However, the possibilityà that the your child die is poor in two ways – less than 1%…. or 30 per 10,000 for those waiting against 3:1,000 for those induced. To prevent a death, 410 women HAVE to be induced.

The analysis can be only good as the research that analyse and there are concerns about the qualityà of the search. The World Organization of the Sanità recommends induction after 41 weeks, based on this analysis, but recognizes that the evidence is “evidence of low quality; Recommendation weak“.

you Can find further critical analysis of the data. Another analysis of the literature in the Journal of Perinatal medicine (Mandruzzato and others, 2010) concluded: “it is Not possible to give a specific età the gestation at which a pregnancy otherwise without complications should be induced.”

One of the major problems with quantitative research is that it rarely answers the question “perché”, and focuses rather on “what” (happens). For example, anormalità defects of the baby and the placenta are associated with pregnancy, post-term, and this può be worth the increased risk rather than the duration (Mandruzzato and others, 2010). The quantitative research also takes a general perspective rather than the risk for a specific woman in a specific situation.

In every way – to pretend that there are no risks associated with pregnancy prolonged (in general) don’t is of help to women looking to make decisions about their options. These general risks should be part of the information that a woman uses to decide what is best for her.

Procedure, and risks of induced labor

Può be difficult to dissolve and isolate the risks associated with the induction perché usually più of a risk factor is done at the same time (e.g. syntocinon, CTG, epidural). I tried to create a mental map, but è ended with the seem as if a spider had made the canvas under hallucinogens. Then I stopped at a written version.

Risks associated with the procedure of induction

The induction process is a processopiuttosto is invasive and usually involves some or all of the things that follow (you can read more about the process of induction here). There are a number of minor side effects associated with these medications/procedures (eg, nausea, discomfort, etc.)

There are also higher risks:

    the

  • Prostaglandins to ripen the cervix (prostin E2 or cervidil): overstimulation that leads to discomfort in fetal and caesarean section.
  • the

  • Rupture of the membranes: discomfort fetal, and caesarean section
  • the

  • IV syntocinon/pitocin:
  • the

  • the Mother – rupture of the uterus; haemorrhage post-partum; poisoning of the waters, which leads to seizures, coma and/or death. the Child – brain damage, hypoxic; jaundice neonatal; haemorrhage neonatal retinal death. There is also research that suggests that there may be a link between the use of syntocinon/pitocin for induction and ADHD (the disorder of deficiency of attention) (Gregory and others, 2013; Kurth&Haussmann, 2011).

The più extreme of these risks are rare, but discomfort fetal and caesarean section are common. The potential effects of hyperstimulation of the uterus on the child are well known (Simpson&James, 2008) – which is the reason why it is recommended that continuous fetal monitoring during induction. This può also explain the association between induction and cerebral palsy (Elkamil and others 2010).

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Risks associated with factors that commonly occur during an induction

The Cochrane review and an analysis of the più recently (Wood and others, 2013) have found a reduced rate of caesarean section in women who were induced. This is a feedback interesting and does not accord with my observations. However, neither of the two analysis separates the primiparous women who have alreadyà had no children. And it is completely different things.

A research study of Ehrenthal and others (2010) found a percentage increase of 20% for women induced to their first child. They concluded that: “The induction of parturition is associated in a significant way with a cesarean delivery among nulliparous women at term… to reduce the use of induction of parturition elective può lead to lower percentages of cesarean delivery in a population“.

another study by Selo-Ojeme et al (211) found induction increased the chanceà of caesarean section 3 times for the first-time mothers. The researchers recommended that ” The nulliparous women should be made aware of this così as to the potential risks of the management of waiting during the counselling.” It is now very clearly established that there are significant risks associated with the cesarean delivery for both mother and child: Childbirth Connection provides an extensive list, and based on the evidence.

The induced labour is usually more painful than a normal birth. The syntocinon (also known as pitocin) produces strong contractions without the gentle rise and release of endorphins contractions natural. Also, instead ofoxytocin natural, syntocinon does not cross the brain blood barrier in order to create the sensations relaxed and doped that help women cope with the pain.

Not surprisingly, the primiparous were more than 3 times the chanceà to opt for an epidural (selo-Ojeme and others, 2011) during an induction.

A Cochrane review has found that: “The women who used epidural had più probability; a delivery più long second stage of birth), required that their contractions of childbirth were stimulated with oxytocin, experienced very low blood pressure, they were unable to move for a period of time after the birth (locking motor), had problems with the flow of urine (fluid retention) and suffered from fever and association between epidural analgesia and instrumental“.

The analysis also found an increased risk of delivery, instrumental or caesarean section for distress fetal with a’epidural.

There are significant risks associated with births with suction cup and forceps, both for the mother and for the child (see link) and the risk of caesarean section.

The study of Selo-Ojeme and others (2011) also reported induction=increased risk of hyperstimulation of the uterus; it tracks frequency of the heartbeat of a foetus “suspicious” and bleeding following the birth.

Not surprisinglybabies born to mothers who had an induction and they had a chanceà significantly less than having an Apgar score of < 5 to 5 minutes and a PH of cord arterial of <7.0 ‘ (basically not in a good situation at the arrival).

another recent study by Elkamil et al (2011) “has found that the induction of birth at term was associated with excess risk of CP spastic bilateral cerebral palsy)…”

let us Remember that we are inducing the birth to prevent damage to the child….

Experience of childbirth

once Again the Cochrane review states: “The experiences and opinions of women about these choices have not been adequately evaluated“.

it Is becoming a theme in the Cochrane review. However, one thing is certain – choose induction altererà completely the your experience of the birth and the options open to you. Women must know that to accept the induction means to accept a continuous monitoring and a drip, the limiterà movement.

The contractions induced are usually the more painful of the contractions of the natural and the impossibilityà to move and/or use hot water (shower or bath) reduces the capacity to do it. The result is that an epidural può be needed. A birth induced, it is not; a birth physiological and requires monitoring (vaginal examinations) and the time stretches out.

Basically you bought a ticket for the roller coaster of the intervention. For many women this is fine and worth the risk, but meeting too many women who are unprepared for the level of intervention required during an induction.

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There have been some attempts to detect the experiences of women on the induction. Heimstad and others (2007) conducted a research on women randomly assigned to induction at 41 weeks or waiting with regular monitoring fetal”. They found that women preferred induction. However, these were women that had been assigned an option rather than having the choice.

another research, Childbirth Connection has asked the mothers of their experience of induction (not necessarily for pregnancy prolonged) – 17% of those induced felt they were under pressure to do so by health care professionals. Citations of the women are also an interesting read.

A study of Hildingsson and others (2011) found that the induction of parturition was associated with a birth experience is less positive and the women who were induced had più probability; afraid that their child would be damaged during birth. However, again this research was not limited to induction for pregnancy prolonged then the women could have had the authentic complications of pregnancy requiring induction.

più recent study in the UK of Hendersin and Redshaw (2013) found that “women who were induced were generally less satisfied with aspects of their care and had a significantly lower probability; to have a normal delivery. In the qualitative analysis the main themes that emerged were related to delay, lack of personnel, neglect, pain, and anxiety in relation to starting the induction, and while it was in progress; and in relation to induction is not successful, the main topics were plans not followed, wasted effort and pain and feeling of being abandoned and disappointment.”

Alternative between waiting and induction medical

Before the labor beginning, the uterus and cervix have the needà to make physiological changes ready to respond to contractions. You think now that the baby is the controller of the “on” button of the birth. So, the baby signals to the mother that he/she is ready, oxytocin is released and the uterus responds.

In comparison to other mammals, humans have the lengths of gestation, the più variables. This suggests that other factors such as environment and emotions (e.g. anxiety) influence also the start of labour. This would make sense considering what we know about the function of oxytocin .

it is also something which the majority of midwives are aware of this – a mother that is stressed has più chanceà to go post the end of a relaxed and tranquil. Having said this, post term is probably the normal duration of pregnancy for many women, no matter what happens. Create ansietà, and the stress close to the due dates and to threaten the induction is probably counter productive to the birth.

There are a number of methods of induction “alternative” or “natural” that are available . However, an induction is an induction.

Try to force your body/baby to do something that it is ready to do is an intervention that is with medicine, herbs, therapies, techniques…, or any other thing. Interventions of any kind can have effects unintended consequences. However, “interventions” (massage, acupuncture, etc,) that aim to relax the mother and to induce trust, patience and acceptance can assist the body/baby to start labor if the physiological changes have già occurred.

Conclusioni

A significant minority of children do not nascerà to 41 weeks of gestation. While the definition of pregnancy prolonged is 42 weeks +, induction is usually suggested during the 41st week.

women must receive adequate information about the risks and benefits involved with both the expectation that with the induction in order to make the choice that is right for them. There are no options without risk.

The risk of perinatal death is extremely low for any of the two options.

I Know women who have lost a baby in the 41st week of pregnancy and women who have lost a child as a result of the induction process.

For the primiparous of the induction process poses particular risks for them and for their children. Each individual woman must decide which set of risks è più ready to face – and be supported in her choice.

Fonte: MidwifeThinking di Rachel Reed

IN ARGOMENTO:

The gravidanza

Labor and delivery, the prodromal phase

Labor and delivery, phase dilatante

Not to give birth before 39 weeks, read because it;

natural Childbirth after a c-section, how to decide

14 settembre 2014