X-Posted: Amniotomy or Pitocin for Induction?

[MandarijnOrange]

If I don't go into labor by Friday morning at 6am, I'm getting induced. My OB will not let me go past 42 weeks for liability reasons (I have GD). She checked my cervix today and declared me very favorable at 3cm, very thinned out, and baby's head is WAY down.

She is letting us decide whether to start the induction with a ruptured bag of water or a low dose of Pitocin and I honestly am having a hard time deciding.

On the one hand, rupturing the membrane seems less 'medical' since it could have happened on it's own anyway. However, if I run into a cord issue, I could end up with a cesarean right off the bat. If I start out with Pitocin, then there are the risks with that too.

My head is spinning. : What would you do?

[maisiedotes]

I had both- they broke my water and then when things were not really moving along they gave me the pitocin and I have to say the pitocin killed me. The contractions were SO strong, I could not stand it. Of course, I don't have all that much to compare it to- our last birth involved a 3-hour labor and 10 minutes of pushing so I can only go by other things I have heard.... I know pitocin makes contractions stronger. I ended up with an epidural (so much for my dream birth!) and I wish I didn't bother with it because it was so painful, by the time he was done I was fully dialated (40 minutes to get the damn epidural in my back and I went from 6 cm to 10 in that time).

I am no help, am I. But I was literally praying for death during my contractions. And I had a big argument with the anesthesiologist in the middle of it all. He was such a twit. I hope everything works out well for you!

[Googy]

OK, I'm overdue and crawling up the wall in boredom, so I decided to research this for you:

Amniotomy
This should only be done after your cervix has started to open and the baby's head is firmly descended in your pelvis. If the membranes are ruptured too early, there is a risk of the umbilical cord slipping down around or below the baby's head (cord prolapse). If the cord gets squeezed between the baby's head and the pelvis bones, the blood supply to the baby may be decreased or stopped.

The risks of amniotomy are:
fetal distress
augmentation of induction with Pitocin
failure of labor to start
increase in fetal malposition
increase in cesarean rates
increase in pain sensation with labor

Pitocin
When inducing labor with pitocin, it works best when the uterus is ready to receive it. Giving pitocin before the uterus is ready or ripe enough to receive it is likely to produce a long drawn out, unsuccessful labor. There are natural and medical ways of ripening a cervix, both having to do with prostaglandins. Ask your doctor what you Bishop's score is before you agree to a pitocin only induction. If it is under 5, labor is likely to be unsuccessful, and you may want to inquire about prostaglandin inductions as well.

The risks of pitocin are:
fetal distress
more likley to request pain medication like an epidural
cesarean section
uterine rupture

Basically, neither of these are great options, but with the GD you are obviously running out of good options. Have you talked about using a foley catheter? There are no real risks to this one. Have you had your membranes stripped yet? This also has no real risks and is generally pretty effective. If these don't work, my understanding is that amniotomy is preferable over pitocin, assuming that your body is ready for it (which it sounds like it is).

Try looking at this link too:
http://www.birthwithlove.com/resourc...ticle.asp?ID=3

[Valerieg]

Would your OB let you do a slow pit drip and turn it off once your body began to labor on its own?

More important than your dilation is the position of the baby's head. If it is favorable, then an amniotomy wouldn't be a bad option. But if the head is still floating I wouldn't even give it a second thought. If not engaged already, this could cause big problems (or not).

Have you and your OB already tried everything else mentioned?

[GinaRae]

I say ask them to strip your membranes tomorrow before you have to decide.

If babe is WAY low, maybe the rupture. Pit next (yuck!!).

[ktbug]

In my experience, (a little different as I had PROM, but still, relevant-ish) my MW was willing to see if the rupture of membranes would get labor started. I was 2cm and baby was way down when my water broke. I didn't go into labor, though, after 24 hours, which was the cutoff point they made for me, so into the hospital I went for a pit induction. They wouldn't consider a slow drip for me because my membranes had been ruptured for longer than 24 hours; their reasoning being that labor had to start NOW NOW NOW because of all the things OBs worry about when water's been broken for over a day.

So, what I'm saying is, if they break your water and you don't go into spontaneous labor, the pit induction will be done aggressively. Or, is often done aggressively. Can't say definitively what your provider's standard of practice is.

And when they crank that pit drip, it f'in HURTS.

For those reasons, if you trust your ob and think they'll listen to you when you say you want a gradual, non-aggressive pit induction, then go for the pit without the AROM. Otherwise, you'll be SOL when AROM doesn't work and they have to reach for the pit (and start you at 10mics/hr ).

ETA: Are you trying natural methods, in the meantime? Sex, nipple stimulation, RRL tea, maybe an herbal tincture or castor oil?

[chrysalis]

Originally Posted by GinaRae

I say ask them to strip your membranes tomorrow before you have to decide.

If babe is WAY low, maybe the rupture. Pit next (yuck!!).

this is the way i'd do it... you are already at 3 cm so that is a great thing... i'd try sex but make sure you orgasm........remember it isn't just about the sperm...orgasm helps too. and you don't necessarily need a partner for that... : catch my drift? the oxytocin from multiple orgasms is great! mmmmmhmmmm you go girl! nipple stim...again, you don't need dh or anyone to do that if you feel shy.......i do that a lot in bed as it is just so relaxing.......i like how it feels thru certain fabrics. how about doing some dancing...girating your hips and pelvis to some music that makes you feel sexy, alive and full of your beautiful mother woman self. some candles going... maybe light a fire in the fireplace if you have one... all that 'feel good' stuff......make out w/ dh if you feel up to it. mmmmmmmmmm i'd love that if i had a SO. get all nice and wet and happy. : if i keep on i'm going about this to have to log off and lock myself in the bedroom. lol

it sounds to me like you are already moving along really well...........already at 3 cm and thinning out well..................you can do this. yeah, if you do wind up in hospital i'd just get there and then keep the nurses/OB away as long as you can possibly do (since you'll be there anyway what are they, gonna kick you out!?)-they can't make you do anything. they can suggest...they can threaten...but your job is to relax and their job is to do what YOU say and suggest...but stop when once said. and then once you do give in, the first thing i'd opt for on their list is breaking your waters......and keep yourself as upright as possible...on hands and knees, squatting, walking, etc. instead of lying on your back. that will get things moving too if you need it. as for the pit, i'd not even do it. say no thanks........and just go w/ the flow of labor...do you have a doula? hang in there! you are going to beat them to the punch, i bet you!!! :