Your Water Breaks First - A Date to PROM (Premature Rupture of Membranes) - Induction Considerations

Article Index

There exists some evidence (albeit not strong) that choosing Pitocin as your induction method of choice slightly decreases your odds of developing an intrapartum (during labor)  infection.

Induction with prostaglandin gel often cause a woman’s temperature to rise anyway, which is a confounding factor in diagnosing infection, and this increases your risk of being clinically misdiagnosed with infection.

As discussed previously, your labor and hospital stay may be shorter, overall.

So Pitocin induction does, on the surface at least, have a few benefits, HOWEVER…

Induction with Pitocin produces very strong, very persistent, very frequent contractions and when the uterus contracts this strongly and frequently it can cause cord compression, fetal heart rate changes and decrease in oxygen to the baby.

Term PROM is also a risk factor for cord compression. This makes Pitocin induction—the go to active management technique for term PROM— a compounding factor—thereby increasing the likelihood of the occurrence of cord compression. THEREFORE…

The choice of immediate induction also means an increase in the number of other technological interventions necessary during labor including continuous electronic fetal monitoring, IV fluids, blood pressure cuff, oxygen monitoring, possible bladder catheterization and almost always the mother’s need for additional pain medication.

All of these interventions limit your ability to move about and choose your own positions. They also potentially increase the risk that you will require a Cesarean Section, especially if you end up using an epidural for pain relief. The limiting of positions also means that there is an increased risk for more severe perineal injuries and lifelong issues with pelvic floor disorders.

One of the pitfalls of being induced is that the intensity of the resultant contractions often lead to the use of epidural pain analgesics. The medical world has yet to determine precisely why but epidurals are a common source of maternal fevers.

If during your labor, you do not have an epidural and you develop a fever, then it is very likely that you also have an infection.

Epidurals confound this diagnosis as epidurals are known to spike fevers and since it is almost impossible to distinguish the source of fever— epidural or infection wise— then doctors fall on the risk management side administering antibiotics and moving toward delivery by Cesarean section.

All of these confounding elements make it more likely that you will be misdiagnosed with infection, opening the door to unneeded antibiotics and a potential cesarean section, this misdiagnosis will have consequences for your newborn as well, requiring them to be tested and treated with unnecessary antibiotics as well.

It bears repeating: “While inductions, like all medical interventions, have their place and time when indicated—they cannot be justified as a standard procedure for a normal physiological occurrence in a healthy full term pregnancy.” Mayri S. Leslie