The wall is beginning to crack. More and more evidence is piling up that all the inductions in the past 20 years for bogus reasons (like oligohydramnios, pregnancy of 41 weeks and gestational diabetes) have harmed women and babies. Of course, the obstetricians would never apologize for this bloodbath. Here’s the latest “study of the studies”–keep in mind that even the biggest, most carefully done studies are suspect in their methodology but, at least this one firmly denounces a number of the favourite reasons for inducing. Gloria
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Indications for induction of labour: a best-evidence review
E Mozurkewich, J Chilimigras, E Koepke, K Keeton, VJ King, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA Correspondence: Dr E Mozurkewich, F4835, PO Box 0264, Mott Hospital, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0264, USA.
Email mozurk@umich.edu
Accepted 2 November 2008. Published Online 4 February 2009.
Background: Rates of labour induction are increasing.
Objectives: To review the evidence supporting indications for induction.
Search strategy: We listed indications for labour induction and then reviewed the evidence. We searched MEDLINE and the Cochrane Library between 1980 and April 2008 using several terms and combinations, including induction of labour, premature rupture of membranes, post-term pregnancy, preterm prelabour rupture of membranes (PROM), multiple gestation, suspected macrosomia, diabetes, gestational diabetes mellitus, cardiac disease, fetal anomalies, systemic lupus erythematosis, oligohydramnios, alloimmunization, rhesus disease, intrahepatic cholestasis of pregnancy (IHCP), and intrauterine growth restriction (IUGR). We performed a review of the literature supporting each indication.
Selection criteria: We identified 1387 abstracts and reviewed 418 full text articles. We preferentially included high-quality systematic reviews or large randomised trials. Where no such studies existed, we included the best evidence available from smaller randomised trials and observational studies.
Main results: We included 34 full text articles. For each indication, we assigned levels of evidence and grades of recommendation based upon the GRADE system. Recommendations for induction of labour for post-term gestation, PROM at term, and premature rupture of membranes near term with pulmonary maturity are supported by the evidence. Induction for IUGR before term reduces intrauterine fetal death, but increases caesarean deliveries and neonatal deaths.
Evidence is insufficient to support induction for women with insulin-requiring diabetes, twin gestation, fetal macrosomia, oligohydramnios, cholestasis of pregnancy, maternal cardiac disease and fetal gastroschisis.
Authors’ conclusions: Research is needed to determine risks and benefits of induction for many commonly advocated clinical indications.
Keywords: Best evidence, indications, induction.
Please cite this paper as: Mozurkewich E, Chilimigras J, Koepke E, Keeton K, King V. Indications for induction of labour: a best-evidence review. BJOG 2009;116:626-636
http://www.ncbi.nlm.nih.gov/pubmed/19191776
Hello. Thank you for this.
Did you personally have any experience with cholestasis?
I crave for a home birth so much. I had 4 hospital births including 3 cholestasis and 2 inductions
This is a cholestasis protocol which was sent to me by a midwife in Australia.
Cholestasis remedy from Nat Dash, Australia (O.C. = obstetric cholestasis)
I use Nat Dash’s info. here it is.
Drink minimum 2 litres of purified water daily. THIS IS MOST IMPORTANT!! (2 glasses of warm water with fresh lemon juice, 1st thing in the morning)
I can’t recommend fresh juice enough; I feel they made a huge difference to my health. I chose to use fresh organic fruit & vegies because of the toxins on the sprayed produce. Washing them in cider vinegar helps to reduce pesticides too though. Large apple, carrot, beetroot, celery & parsley, 3 times a day, 20 mins before a meal. Great for flushing out those toxins!!!
Pineapple & parsley is great for keeping up iron levels.
Porridge/oats made with water or rice milk – great for lowering rising cholesterol, which generally happens with O.C
Raw mushrooms also helped me a lot. I ate about a kilo a day. Later I found out that mushrooms are also beneficial to the liver.
Take all fats out of the diet. None or limited dairy products & meat. These are oestrogen forming… one of the contributing factors involved in Cholestasis is over production of oestrogen.
Deep sea ocean fish would be the best alternative & full of omega 3. If vegetarian, Flaxseed oil is fantastic & great for the skin.
Herbs made up by a qualified naturopath, as listed in article – psyllium husks, dandelion, slippery elm, globe artichoke, milk thistle etc.
Guar Gum is a natural gel-forming fibre & has been very successful in aiding women with this condition by increasing faecal elimination of bile acids. Tablet or powder form should be available from health food store or natural health professional.
Metamucil also helps to bind the bile.
Acupuncture was used throughout my preg to assist with good liver function & for preparation & assistance with natural induction. Acupuncturist needs to be competent working with pregnant women & liver conditions.
Relaxation – Yoga, meditation, stretching, deep breathing, Reiki can all be helpful for both mind & body. Good preparation for labour also!!
Some women find it difficult to retain vitamin K with this condition (vit k is necessary for blood to clot).
Here are some suggestions to minimise bleeding/ Postpartum Haemorrhage (PPH):
Have blood tests to check haemoglobin at 36 weeks; use natural means to help avoid anaemia or supplement – floradix, Spatone etc
Take a good quality multi vitamin for pregnancy
Take alfalfa, 4 – 8 tablets per day, any brand. Alfalfa contains every vitamin & mineral, as it’s roots go extremely deep into the soil – it is an excellent source of vit k
This has worked in my experience.
Lisa