Article by Sarah Wickham, translated by Catherine
Zhytomyr. Printed in AIMS magazine (AIMS – Alliance for
The Improvement of Maternity Services – Public British
organization “Union for the Improvement of Maternity Services”) AIMS
JOURNAL Vol: 26 No: 2 2014 6-8
In modern Western culture, most women know about
stimulation of labor even before they become pregnant.
They know that stimulation is offered, if it is believed that for
a child will be safer to be born than to remain in the womb.
I also suspect that many women know that one of the main
reasons for the appointment of stimulation – is the period of pregnancy, after
which the child is considered to be “postponed.” Also many women
know some other women who have been stimulated to give birth, so
they are aware of other stated causes of stimulation. These reasons
a woman’s age may be higher than “normal”, and
premature rupture of water, and / or health problems, as well as
pregnancy complications in which the induction of labor can
prove necessary But that is not all. Have a decision whether to agree or not
on the stimulation of childbirth, there are still many aspects that also
has washed to take into account. I spent the last few
months to study this topic. The result was a recent edition.
(revised and enlarged) of my book “Stimulation of childbirth: take
informed decision ”(Wickham S (2014) Inducing Labor: making
informed decisions. AIMS, London). In May for the presentation of this book
in Bristol, I prepared a presentation entitled “10 facts about
стимуляции родов, которые стоит know every woman». I do not
I was going to dwell on well-known things (see above),
instead I wanted to draw your attention to some
facts, circumstances and assumptions that are less known and
which it may make sense to take into account when we take
stimulation decision. In fact, of course, it is worth knowing much
more, so my list of ten facts is just the starting one
platform for discussion, rather than comprehensive information on
1. It does not look like normal childbirth.
This is clear to some, but I know from experience that not everyone. Stimulated
childbirth is very different from childbirth, which began spontaneously.
Of course, every woman has her own personal childbirth experience, but there are
differences that are almost universal. First, for
stimulate childbirth a woman is injected with a synthetic hormone, which
causes more pain than spontaneous labor. And this comes
the pain is faster. Synthetic hormones, unlike our own
hormones do not cause the release of painkillers into the blood,
which during normal labor are produced by the female body.
In addition, stimulation can have side effects, and this
It means that to observe such a woman will be more intent. Such
more close observation may limit
mobility of women, which increases stress and, accordingly,
pain, and this, in turn, can cause a woman to feel that
the situation is out of control.
2. It hurts
I have already started talking about this in paragraph 1, but there are also others.
sources of pain that I think women should be aware of
how to make a decision. For example, contractions caused by
prostaglandin gel or balloon that is often used on
The first stage of labor stimulation can quickly become painful on
the absence of any visible effect. It gives a negative
experience of childbirth, moreover, in such a situation it is easy to get tired and / or
lose your presence of mind much earlier than at an early stage
spontaneous birth. Oxytocin contractions can also
to be very strong, and often time to adapt to them,
women less than spontaneous delivery. More frequent vaginal
research and other manipulations (for example, using a balloon)
may cause additional pain. 3. “Service
goes in the package “
I wrote a lot about this on my website (www.sarawickham.com), so
that I will not be particularly repeated. But the fact that me
continue to ask whether physiological management of the third is possible
period (birth of the placenta), as well as the rejection of CTG and / or
vaginal examination in case the birth was
stimulated, makes you think that this is not a well-known fact.
Not that anyone wants to prevent a woman from making the right decision. But
drugs that are used to stimulate labor are sufficient
powerful. They block the release of their own hormones, and this can
cause problems for a woman and a child. And so the influence of these
drugs that stimulate childbirth, you need to evaluate, control and,
compensate if necessary. If a woman believes that such
the side effects of stimulation are not what she needs,
perhaps it is better to ask yourself whether this stimulation is necessary at all.
4. Departure of fetal membranes is not so
Nowadays, a lot of where it is taken at some stage of pregnancy
offer women “peel off” or “separate manual »fetal
shell in the hope that it will reduce the number of women
needing medical stimulation. Even if we
ignore the assumption that all women who are offered
stimulation, agree on it, we must understand that the department
shells can cause discomfort, bleeding and
irregular contractions, while the results of some
This procedure accelerates the onset of labor by only 24.
hours The review published in Cochrane concludes: “Not
it seems that the routine use of manual separation of shells starting
from 38 weeks gave significant clinical benefits.
Conducting this manipulation to stimulate childbirth should be considered.
coupled with the discomfort of the woman and other side effects
procedures ”(Voulvain M, Stan CM, Irion O (2005) Membrane sweeping
for induction of labor. Cohrane Database of Systematic Reviews
2005, Issue I. Art. No .: CD00451. DOI:
10.1002 / 14651858.CD000451.pub2).
5. “Natural stimulation” is
I also wrote about this in another place, and this article can be
read on my site (Wickam S (2012) When is induction not
induction? Essentially MIDRIS 3 (9): 50-51), but the basic idea is easy
state: either we are waiting for the natural onset of labor, like this
happens according to natural laws, or we are trying to intervene and
cause childbirth earlier than they would begin. Sometimes to summon
There are good reasons for childbirth, but if a woman takes castorca or
asks your midwife to manually separate the fetal membranes daily
or chooses some other “popular” method of stimulation, it means
is going to call its birth with non-drug means.
Please note, I’m not trying to say that something is wrong here,
but I believe that since we live in a culture that
devalues female bodily functions, it is important to clearly understand what
same our intentions.
6. This is NOT a law
While I was writing a book, I was amazed to find out that the hotline
AIMS received a call from a woman whose midwife said, “We must
You stimulate 24 hours after the discharge of water. it
law. “This woman agreed to the stimulation of childbirth, which
proved to be very traumatic for her. I want all women
knew that there are no laws that define what should
or what a pregnant woman should not do. And me, and AIMS it
very disturbing. Every medicament claiming this should be
report to higher organizations. Any threatened woman
in any way or just state something like that, we ask
contact AIMS for informational and other support.
7. it не «просто капелька»
I am always worried when I hear in the words of midwives or doctors
underestimation of the recommended intervention. I especially do not like
the expressions “droplet” or “slightly help” used by
with respect to the intravenous drip of oxytocin. it
a powerful drug, and so it should be treated. It can cause
fetal distress, and in some clinics it is generally accepted to increase
dose of oxytocin until the child responds with distress (!), and
only then they stop increasing the dose – it is believed that such
the proper level of oxytocin is determined. But даже когда дозу
oxytocin cease to increase as soon as established
effective contractions, this drug must be treated with
attention, and professionals should not be underestimated, it does not matter
intentionally or not, its effect. 8. The female body will not fail.
Stimulation and system – easily
The name speaks for itself. Stimulation does not always work,
and the woman is not to blame. I would like to dissuade everyone
women whose childbirth unsuccessfully stimulated what happened to them and their bodies
everything is good. it ещё один случай, когда некоторые выражения,
used in rodbloke, clearly worth reconsidering.
9. Risks of delay come later, they are lower, and their
harder to prevent
Below I give the data that I use here and in the book.
it обобщение результатов исследования, изучавшего риск
stillbirths at different stages of pregnancy. If you look
on the values - and I especially ask you to compare the risks at 37 and 42
week of pregnancy – you will see that increased risks occur
not at all as early as many think, and that increasing the risk is not
as strong as it is often supposed. Actual birth outcome
in women who have been waiting for a spontaneous onset of labor
activities, and women who gave birth with stimulation had
so similar that no single study
comparing childbirth with stimulation and spontaneous childbirth, not
able to demonstrate the benefits of stimulation. Only when these
studies were brought together, it became possible to notice small
the differences. However, the quality of one of the studies (just
that pushed the scales) leaves much to be desired. Based
This, I want to ask, is there any from the current protocols,
offering stimulation of labor after 40 but up to 42 weeks, the real
benefit. The book on this topic says much more, including
presented a full review literature on the topic.
Risk of stillbirth of unclear etiology at 35 weeks
1: 500 for a period of 36 weeks 1: 556 for a period of 37 weeks 1: 645 for a period of 38
weeks 1: 730 for a period of 39 weeks 1: 840 for a period of 40 weeks 1: 926 for
a period of 41 weeks 1: 826 for a period of 42 weeks 1: 769 for a period of 43 weeks
Taken from Cotzias CS, Paterson-Brown S, Fisk NM
(1999) Prospective risk of unexplained stillbirth in singleton
pregnancies at term population based analysis. BMJ 1999; 319: 287.
doi: dx.doi.org/10.1136/bmj.319.7205.287 10.
Risks for old-aged are not as certain as is customary.
The final point relates to the statement that with increasing
women’s age risks increase and so their childbirth needs
to stimulate. Indeed, some studies suggest
the correlation between increasing maternal age and increasing number
some complications, but there are several reasons to treat
this data with caution. Older women are more likely
are examined and more likely to undergo various interventions, and this
by itself can cause complications. �Older women more often have
health problems and it’s hard to say what is causing
Complications – a woman’s health condition or her age.
Studies that dealt with this problem do not always separate.
one from the other, and in those studies where this was done,
women who gave birth long ago and who cannot
compare with today’s women. So in this area
Extremely lacking material, and modern research on this
theme, unfortunately, led only to the fact that increasingly stimulate
and younger women and earlier terms so that from
The results of such studies for women also do not have much benefit.
A day or two after my report I asked some
colleagues, what facts would they list, and they suggested
many interesting points. It was not ten facts, but dozens
and almost hundreds of things that we would like to know
women. But at least this is the beginning. You can find more
information about this (and many other things) in the book “Stimulation of childbirth:
make an informed decision ”, published by AIMS. Currently
Our goal is to bring this information to as many as possible.
women before they decide to stimulate.
Sarah Wickam – midwife, teacher, author and researcher,
She had an extensive and varied practice and also was engaged in
obstetric education, research, published articles and
books. Currently Сара организует семинары «Рецепты
normal delivery for midwives and other professionals working
in obstetrics, writes books for AIMS, speaks at various
seminars and conferences, many consults and twice a week
keeps a column on his website www.sarawickham.com, where you can
read many of her articles. Her latest book is Stimulation of Childbirth:
make an informed decision. ”