Pitocin & Episiotomies
Induction: Kick-Starting Contractions
What it is: Intravenous Pitocin (oxytocin) is a synthetic hormone that a doctor or a certified nurse-midwife administers to stimulate contractions.
Why it's done: Pregnancy lingers two weeks or more past the due date; labor stalls -- or doesn't start after membranes rupture. The longer the baby remains inside the womb, the greater the risk of uterine infection in the mother.
Possible problems: Contractions come on fast and hard and sometimes are unrelenting. "Fortunately, Pitocin clears from the system within moments when we stop the IV," says Jeffrey Goldberg, MD, clinical assistant professor of obstetrics and gynecology at Jefferson Medical College of Thomas Jefferson University, in Philadelphia.
If you're intent on an all-natural birth, realize that being induced usually means staying flat on your back, says Patricia Crane, certified nurse-midwife and director of Nurse Midwifery Services at the University of Michigan, Ann Arbor.
Episiotomy: A Cut Below
What it is: A cut in the perineum, between the vagina and rectum. Unless an epidural is in effect, the doctor or nurse-midwife applies local anesthetic before using surgical scissors.
Why it's done: A wider opening may speed delivery if the baby's in a difficult position.
Possible problems: While some providers routinely do episiotomies, the latest research shows no benefit -- and even potential harm. "Twenty years of data show there's no evidence for what were believed to be benefits: less pain, faster healing, and sexual functioning," says Dr. Hartmann, lead author of a review of 986 related studies on episiotomies.
In addition, all episiotomies require stitches, compared with just one out of three uncut deliveries, and they may even cause further tearing, says Dr. Hartmann. In fact, Dr. Goldberg and his colleagues found a 16 percent risk of severe tearing with episiotomy -- four times the risk without incision. In addition, he says, episiotomy makes injury to the anal sphincter (which can lead to bowel incontinence) four to 10 times more likely. More common, less serious side effects include bleeding, bruising, and pain for two or three days.
Postnatal pointers: Apply ice for the first 12 hours to reduce pain and swelling, use a squirt bottle for post-toilet cleansing, and keep the area dry. "Use a hair dryer on a low setting after showering, and skip underwear if you feel comfortable with that," suggests ACOG spokesperson Iffath Hoskins, MD, chair of the department of obstetrics and gynecology at Lutheran Medical Center, in Brooklyn. "Warm compresses are also soothing and increase blood flow to speed healing." Call your doctor if discomfort persists for more than a week, which could signal an internal blood clot or infection.