Induced Labor and Informed Consent in Canada
by Gail J. Dahl

"It is apparent that the overwhelmingly redundant message of the ... literature ... is that there is absolutely no study, no evidence whatsoever, that routine induction at any gestational age improves perinatal outcome" (Nichols 1985a).

I began to be interested in induced labor shortly after I experienced a birth induction, also known as induced labor, forced birth, scheduled childbirth, daylight obstetrics, Vitamin P, and also described as "a little something to get you going." My daughter was born in a large Canadian city hospital in 1995. Nearing the end of the last trimester, exactly one week after a 40 week due date, I was told by my obstetrician that my baby was overdue, my baby was starving, weighed only five pounds, and that my placenta was aging. He also mentioned it was hospital policy to induce labor at 41 weeks gestation. Reasons given on hospital records for induction were recorded as low weight and fetal distress. Although I had read many books during my pregnancy, I did not find any references on induced labor or its relatively high risks and possible side effects. After thinking it over during the weekend I had difficulty coming to terms with the suggested route of care. Weight gain throughout pregnancy was normal; the mother was healthy and the baby was healthy during the previous ten prenatal visits. I resigned myself to the obstetrician's advice, however, and arrived at the hospital on Monday morning, highly concerned with the health of my baby.

As the prostaglandin gel (also known as Dinoprostone, Prostin E2, PE2, or Prepidil) was inserted, I began to have serious misgivings about the procedure. I asked if I could leave the hospital to move about during labor. The obstetrician looked at me and said, as this procedure was still relatively new they could not be sure of its effects, so I would not be allowed to leave. My labor started with a bang, and I was soon overwhelmed with violent, unceasing contractions-a hypertonic reaction to the drug. Only because of the tremendous emotional support and technical support from the nurse-midwives and others on my team was I able to give birth normally and avoid an emergency cesarean operation.

The Compendium of Pharmaceuticals and Specialties (2000, 35th ed.) details the adverse effects and risks of induced labor including fetal distress, failure to progress, failed induction leading to episiotomy and forceps delivery or emergency cesarean operation, hypercontractility, and fetal heart rate abnormalities. Contraindications include: patients with a history of cesarean section, major uterine surgery; patients with cephalopelvic disproportion; patients with a history of difficult labor and or traumatic delivery; grand multiparae and six or more previous term pregnancies. Patients with suspected or clinically evident pre-existing fetal distress, patients with overdistention of the uterus, multiple pregnancy, polyhydramnios; patients with pre-existing uterine hypertonus; circumstances that make it impossible for a responsible physician to be present. Also contraindicated are patients with ruptured membranes, engagement of the head has not taken place; patients with unexplained vaginal bleeding during this pregnancy, patients with fetal malpresentation; patients with gynecological, obstetrical or medical conditions that preclude vaginal delivery.

During the labor, I often felt as though my womb was being torn from within me, and I began to hemorrhage. It took months and months for the bleeding to stop entirely and the pain in my womb to subside. When my daughter emerged from my womb and was placed on my breast a refrain was whispered throughout the room, There is nothing wrong with this baby. As I gazed into her eyes, I began to feel the white-hot rage of betrayal. She had obvious signs of prematurity including a covering of soft down-lanugo and vernix. This was not an overdue baby, but a premature baby. Her medical records record her at barely 40 weeks. She could have easily been two or three weeks premature.

We were both out on the sidewalk two hours after her birth on an early-release program. Within 24 hours she began to cry, establishing a pattern of three or four hours consecutively in the evenings for months after the birth. She soon developed eczema covering her entire body. That was only the beginning. Soon we found out at the hospital that she had multiple allergies, which included dairy, soy, eggs, Tylenol and various environmental triggers. This became noticeable after breastfeeding was stopped. Then her asthma started. After that, we dealt with her brain seizures. The emergency ward doctors at the children's hospital suggested a daily treatment of drugs to prevent seizures. Unfortunately, the drugs had the potential to cause more side effects than the seizures. We decided to look for other ways to assist her in reclaiming her health.

Later I realized we both experienced many side effects from an adverse reaction to the induction drug. I experienced bleeding during labor and prolonged bleeding for months after the birth, blood pressure problems, prolonged and severe postnatal depression, reduced immune function, and persistent pelvic pain. My daughter experienced reduced immune function, which contributed to eczema, asthma, allergies to foods and environmental substances, and brain seizures. Pharmacia & Upjohn report the following adverse effects with this particular prostaglandin: vomiting, nausea, diarrhea, fetal heart rate changes, uterine hypertonus, headache, hypertension, postpartum hemorrhage, fever, dizziness, chills, hiccough, flushing tachycardia dyspnea, bronchospasm and rash. A case of seizure is reported with this product, as are seizures from the other prostaglandin drugs used to induce labor. This drug is also used as an abortant.

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