Making a Choice
Any pregnant woman may find herself in a position where she needs to be induced for medical reasons, and all moms-to-be should be aware of this possibility. Induced births are often wonderful experiences, and fortunately with modern medicine it is possible to induce delivery of a baby who might otherwise suffer from serious health risks.
But, when faced with the option of an induction, especially a selective one, women need to know of the risks and the facts. In deciding which kind of delivery practitioner you want to use, consider each one's stance on drug-induced labor.
Doula Robin Elise Weiss believes that "in general you'll probably find OBs are quicker to jump to pit [in using Pitocin] than midwives, though it's certainly case by case." In addition, an OB-GYN who works for a private practice may have a different policy on inductions than a doctor who works in a hospital setting. The latter will need to follow the hospital's protocol, says Ratta. She adds that while she does use Pitocin in deliveries, she will not perform an induction simply because a patient requests one. "It is not what midwives do," she says, and in fact, she "strongly advises against [a non-medically necessary induction] as it is inherently risky."
Dr. Kritz believes that selective induction goes against the traditionally, non-interventionist philosophy of the family practitioner, as well. If she induces a delivery, it is typically because a woman has gone into labor on her own but is not progressing.
Expecting women also need to think about the delivery process and their faith in their bodies. "I think Pitocin is over-used in many ways," says Weiss. "You see it used routinely for the delivery of the placenta, rather than waiting or allowing nature to take its course. At the births I've been present at, I find it being used more and more, particularly without waiting for the woman's body to kick in." That said, many women don't mind not waiting for their bodies to kick in and prefer to be in control of the labor experience. As long as they understand that "Pitocin is not a benign drug," warns Dr. Kritz. Pitocin, like "any medication used well, can be wonderful, and like any medication used improperly, can be a disaster," says Dr. DiLeo.
Given the ease with which doctors induce, many women when offered the possibility of ending their pregnancies early, feel thrilled, but are simply never made aware of the risks. Many women are uninformed, says Ratta, and it is left to the physician, who is often pressed for time, to teach them. "I don't believe women get true informed consent, about most anything, including Pitocin," says Weiss. Informed as pregnant women may be, once in the delivery room—in labor, and possibly on painkillers—many women feel vulnerable. A birth plan that takes many different possibilities into account can help you be prepared, and empowered to make decisions consistent with your personal needs and values should any unexpected events occur during delivery. In the end, remember that the most important part of the delivery process is the little person you're delivering.