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Pitocin Induction

Inducing Labor in Late Pregnancy

A pitocin induction of labor is used in late pregnancy to initiate labor. Different methods may be used to soften the cervix prior to the use of pitocin for labor induction. The different methods of medical induction of labor in pregnancy are discussed, including risks and benefits of each.

In an increasing number of pregnancies, labor is induced, or started, medically. The most common reasons include:
  • Post-dates pregnancy (two weeks past the due date)
  • Expected large baby (referred to as large for gestational age - or LGA)
  • Medical complication such as pre-eclampsia or diabetes
  • Desire of parents (social induction)

How often is labor induced?

The rate of pitocin induction changes dramatically from one site to another; and even from one part of the week to another.

In general, the national labor induction rate is around 40%.

Risk and Benefits of Pitocin Induction

Benefits of Inducing Labor

  • Deliver a baby when the pregnancy might be at-risk if it continued
  • Prevent post-dates pregnancy with an over-aged placenta
  • Prevent large for gestational age infant (LGA)

Risks of Inducing Labor

  • Increase rate of cesarean with failed pitocin induction (almost 50% of inductions of labor result in cesareans)
  • Pre-term delivery
    • Miscalculated due date resulting in younger gestation than expected
    • Late pre-term delivery after 36 weeks that still needs time in NICU for respiratory problems

Is the Cervix Ready for Induction?

Bishop Score of Cervical Readiness

Prior to a pitocin induction, the condition of the cervix is evaluated during a pelvic exam. The Bishop Score is a measurement that is done to assess the readiness of the cervix for dilation.

It is similar to the Apgar score of newborns done at birth in that it also assesses five different criteria. These are:
  • Amount of dilation in centimeters
    • 0 Points: No dilation
      1 Point: 1-2 cm
      2 Points: 3-4 cm
      3 Points: 5 or more cm
  • Degree of effacement
    • 0 Points: 30% or less
      1 Point: 40-50%
      2 Points: 60-70%
      3 Points: 80% or more
  • Fetal station
    • 0 Points: -3 or higher
      1 Point: -2
      2 Points: -1
      3 Points: 0 or lower
  • Degree of cervical softness
    • 0 Points: firm consistency
      1 Point: medium consistency
      2 Points: soft consistency
  • Position of the cervix as posterior or anterior
    • 0 Points: Posterior
      1 Point: Middle
      2 Points: Anterior
Unlike the Apgar Score which assigns up to two points for each category, the Bishop Score gives up to three points. For consistency and position, only two points are possible.

Use of Bishop Score in Pitocin Induction

If the Bishop score is eight or higher, the cervix is considered ready for induction. Current guidelines would use pitocin as the only induction agent with a cervix having a score of eight or higher.

With a score lower than seven, the cervix is not ready for induction of labor. There is a higher chance of having a failed induction with a cesarean in those cases.

IV Pitocin

Pitocin is the synthetic form of the human hormone oxytocin which is responsible for uterine contractions. Pitocin is used both to induce labor in a non-laboring woman and to augment contractions in a woman whose labor is not progressing as quickly as desired.

Pitocin is administered through an intravenous pump.

Risks of Pitocin

  • More painful contractions
  • Hyper-stimulation of the uterus (More than five contractions in ten minutes or individual contractions of more than 90 seconds)
  • Increase in the number of cases of fetal distress in labor, uterine ruptures and emergency cesareans
  • Cesarean for failed induction

Pitocin Induction or Augmentation

Fortunately, most labors will be neither preterm nor postdates. But even when labor starts “on time” there may be instances when labor progression is slow.

In those situations, contractions are often augmented with pitocin.
  • Induction = Starting labor in pregnancy
  • Augmentation = Enhancing contractions once labor has already started Pitocin, whether used for induction or augmentation, has several risks. The risks include more painful labor, often resulting in the use of epidural anesthesia. Pitocin increases the occurrence of fetal distress, leading to a higher cesarean rate.

Alternatives to Medical Induction of Labor

Not all mothers wish to have their labors induced or augmented by medical procedures. They frequently ask what they can do to enhance their contractions and the likelihood of a labor that progresses efficiently and naturally.

Check back for more information on ways to avoid labor inductions.

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By Karen Newell Copyright 2003 - 2012 Better Childbirth Outcomes - All Rights Reserved
Camp Hill, Pennsylvania, USA