Bishops Score

Before considering labour induction, you can determine your chances of a successful induction by scoring yourself using the Bishops Score table, below.

A lower score can mean induction may be more difficult, longer, and will most likely be harder on you and your baby.

The higher the score, the more favorable the cervix. Clinical trials showing a score of 6-7 or more were associated with successful inductions, but most agree that a score of 9 is preferable.

Cervix	Score
	0	1	2	3
Position	Posterior	Mid-position	Anterior	---
Consistency	Firm	Medium	Soft	---
Effacement	0-30%	40-50%	60-70%	>80%
Dilation	Closed	1-2cm	3-4cm	>5cm
Baby's Station	-3	-2	-1	+1, +2

Further Bishops Score considerations:

Add 1 point to your score for:

• Preeclampsia
• Each prior vaginal birth

Subtract 1 point from score for:

• Postdates pregnancy
• Nulliparity (if this is your first baby)
• Premature or prolonged rupture of membranes

Induction Increases Cesarean Rate

REALLY? No... You must be joking.

Ok, so enough of my sarcasm and on with the facts...

To start with, here is the full text of the article.

NEW YORK (Reuters Health) May 15 - Elective induction of labor significantly shortens the active phase - by an hour, on average - but nearly doubles the risk of cesarean section, researchers report in the May issue of Obstetrics and Gynecology.

Did you get that, one hour. You are shortening your active labor time by one hour, and in return, you're doubling your chances of getting major abdominal surgery. What is the draw here?

Forgive me, I'm feeling annoyed about our skyrocketing induction and c-section rates. No, make that ANGRY.

With all this hot-air about health care reform and lowering health care costs... what on earth are we letting happen in Maternity Care? No matter how many studies are done, no matter the results.. nothing is changing. Studies have shown over and over that modern obstetrical protocols are causing more c-sections, more deaths and more bad outcomes than the traditional methods that midwives use.

This is NOT rocket-science people. Why is it so hard for us to understand that a c-section is not a minor, no-big-deal procedure? When are we going to start telling women openly , honestly that c-sections are major surgeries, with major risks, both for the current and in the future when that same woman gets pregnant again, and maybe again after that?

The induction rate MUST be addressed. It's insane for this many women to be consenting to inductions that are completely unnecessary.

You can wait another 2 weeks for your baby to be born. They will be healthier for it, and so will you... and so will the rest of the babies you have.

Tell me, which looks like more fun?

THIS ONE



OR

THIS ONE



Ok, rant done. Go ahead - call me the EVIL, ANTI-INDUCTION DOULA.

Oligohydramnios

Oligo-wha-huh?

Oligohydramnios is the condition of having too little amniotic fluid.

What causes it?

Birth defects – Problems with the development of the kidneys or urinary tract which could cause little urine production, leading to low levels of amniotic fluid.

Placental problems – If the placenta is not providing enough blood and nutrients to the baby, then the baby may stop recycling fluid.

Leaking or rupture of membranes – This may be a gush of fluid or a slow constant trickle of fluid. This is due to a tear in the membrane. Premature rupture of membranes (PROM) can also result in low amniotic fluid levels.

Post Date Pregnancy - A post date pregnancy (one that goes over 42 weeks) can have low levels of amniotic fluid, which could be a result of declining placental function.

Maternal Complications - Factors such as maternal dehydration, hypertension, preeclampsia, diabetes, and chronic hypoxia can have an effect on amniotic fluid levels.

Ok, so now for the real post - Should you be induced because your doctor performs an ultrasound and says you have low fluid? Hmmmm..

It depends (as usual). How low is low? An AFI (amniotic fluid index) that is less than 5-6 = oligohydramnios, but...

On the other hand, a low AFI (oligohydramnios) at or near term may be an indication for delivery, either by induction or C-section. If there were to turn out to be a normal amount of fluid with rupture of membranes during an induction, then the low AFI that prompted the induction was either temporary or wrong. - http://www.gynob.com/biopamfl.htm

Notice the word temporary.

Notice the word wrong.

Some interesting information:

It is important for parents to know that this is likely an inaccurate assessment. What the ultrasound technician is doing could be compared to viewing an adult in a see-through plexiglass bathtub from below the tub. In such a scenario, it would be difficult to assess how much water is in the tub above the body that is resting on the bottom of the tub. You might be able to get an idea of the water volume by measuring how much water was showing below the elbows and around the knees, but if the elbows were down at the bottom of the tub, too, you might think there was very little water. This is what the technician is trying to do in late pregnancy—find pockets of amniotic fluid in little spaces around the relatively large body of an 8 lb. baby who is stuffed tightly into an organ that is about the size of a watermelon (the uterus). If most of the amniotic fluid is near the side of the uterus closest to the woman’s spine, it can not be seen or measured. - Gloria Lemay's Blog

Now, how do you know whether is a true case of "Oligo" or not? Well, there are several things that should be taken into account.

What gestation is your pregnancy?

If you are post dates, is the fluid "low" because the baby is big and the assessment is wrong? How do you tell? Why not get some IV fluids and then get another ultrasound? If you were borderline low, is it back into a normal range now? Maybe you could go home and drink drink drink and come back in the morning for another ultrasound?

Is the baby in any distress? Are you doing kick counts and getting 10 movements in an hour?

What if you are only 38 weeks and your AFI is showing 1? Way too low. And induction is probably very necessary.

So, here's the point. If your doctor says, "Your fluid is low, we need to induce.", don't blink blindly and say, "ok". Ask some questions.

What is my AFI?
Did you do a Biophysical Profile, and what are the results?
Can I get some fluids (IV, etc.) and retest?

Can low fluid be dangerous? Of course! And for that reason you should always pay attention to any diagnosis you are given. Oligohydramnios is more dangerous in the 2nd trimester. It is sometimes associated with other dangerous pregnancy complications. True low fluid in post dates pregnancies is associated with labor complications.

The problem is that it is very often hard to determine "oligo" with certainty.

As usual, be an active participant in your pregnancy and birth. There is nothing wrong with asking questions, even if you decide to take your doctors recommendations.


**Blog Post included in the Lamaze Healthy Birth Practice Blog Carnival**
COOL!

Pit to Distress

While I feel very lucky that all the births I've attended thus far have been induction and pitocin free, I know there will come a day when a client faces pitocin.

With all the birthy information that I read about or talk about on a daily basis, I have not heard of this. Honestly (and unfortunately), I am NOT surprised. The fact that there is even a need to inform women of this, disgusts me.

"Pit to Distress": Your Ticket to an "Emergency" Cesarean?

“Pit to distress.” How have I not heard about this? Apparently it’s quite en vogue in many hospitals these days. Googling the term brings up a number of pages discussing the practice, which entails administering the highest possible dosage of Pitocin in order to deliberately distress the fetus, so a C-section can be performed.

Yes folks, you read that right. All that Pit is not to coerce mom’s body into birthing ASAP so they can turn that moneymaking bed over, but to purposefully squeeze all the oxygen out of her baby so they can put on a concerned face and say, “Oh dear, looks like we’re heading to the OR!”

Ok, so here is my advice.

First, read the blog entry from Jill at Unnecesarean (above).

Next, read my blog on Labor Induction.

Next, don't induce unless it is medically necessary.

Finally, do some research on pit protocols and ask your doctor and hospital what their policy is. Do they jive? Does it sound like too much? Will they agree to a lower or slower pit induction?

If not... RUN.

Shame on OB's that practice this way.

Labor Induction

One of the most common things that I hear among pregnant women is regarding induction. My insides cringe when I hear "I was induced"...

As our society has slowly placed more and more emphasis on the "due date", we have forgotten that babies don't keep a calendar with them in your womb. Each baby is unique. It grows at it's own pace. And frankly, it should be allowed to pick its OWN birthday. Why? Because it is safer. Safer for your baby, and safer for you.

Babies that are induced before they are ready can have trouble breathing, staying warm and breastfeeding, and they often need special hospital care after birth. In fact, we are seeing a large increase in preterm births, mostly due to the fact that we are inducing and sectioning babies way before they are ready.

It's isn't devoid of risk for mothers either. Research shows that first-time moms who are induced are twice as likely to have a cesarean as one whose labor starts on its own.

Actually, I've only scratched the surface here. The other risks involved are being confined to your bed, IV fluids, continuous fetal monitoring and denial of food and drink. These often lead to epidurals, because induced labors are significantly more painful. Epidurals lead to catheters and internal monitors. They can even lead to an assisted delivery with a vacuum or forceps. AND as mentioned above, inductions often lead to a cesarean, usually for fetal distress or stalled labors. Oh, and did I mention that sometimes an induction just doesn't work at all?

My advice to any pregnant woman... skip the elective induction. No matter how miserable you think you are, no matter how many times your well meaning friends call and ask if you've had the baby yet, no matter how tempting it is to schedule when you are going to meet your baby... be strong, for yourself, for your baby and for your birth.