Labor Induction
When Is Labor Induced? Methods Explained

Labor Induction

Contents

• Introduction
• When Is Labor Induced?
• What Methods Are Used?
• What Are The Risks?

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Introduction

Labor induction is the procedural use of drugs or other methods to bring on (induce) labor by stimulating uterine contractions. Labor is not usually induced before week 39 of pregnancy unless a specific pregnancy complication requires a doctor to do so. About 20 percent of all pregnancies in America are induced. There are risks associated with labor induction, such as infections and possible need for a Cesarean section. However, statistics indicate that the benefits usually outweigh the risks.

When Is Labor Induced?

There are many reasons for inducing labor, including the following:

1. Pregnancy is overdue (postmaturity): more than 42 weeks have passed and labor still has not started naturally.
2. Pregnancy is causing high blood pressure.
3. The mother has a health condition which could harm herself or the baby, such as preeclampsia, gestational diabetes, epilepsy or high blood pressure in pregnancy.
4. An infection of the uterus has been diagnosed.
5. Placental abruption has happened where the placenta begins to deteriorate, separating from the wall of the uterus before the baby is born. A C-section will probably need to be performed.
6.Waters break but there is no sign of contractions: otherwise known as premature rupture of membranes.
7. The baby has stopped growing at the expected pace.
8. If you live far away from a hospital or birthing center and you are full-term, labor may be induced to help avoid an unattended delivery.

Some women request labor inductions so that they can schedule their childbirth and delivery time. They do so to avoid inconveniences at home or work, but this is generally not recommended. In fact the Food and Drug Administration has opposed elective inductions since 1978 - that is, inductions carried out for convenience.

What Methods Are Used?

There are various methods for inducing labor (including natural labor induction techniques), some can be performed in your health care provider's office, and others need to be performed in hospital.

Dilating the Cervix

Sometimes called ripening of the cervix, this method can include drugs or medical devices to soften the cervix, allowing for more stretch. Prostaglandin drugs (a synthetic form of the chemicals naturally produced by the body) can be taken orally or inserted into the vagina. Sometimes a hormone jelly (Prostaglandin or Prepidil gel) is applied to the cervix to ripen it and thereby producing contractions. Applications can be repeated after 4 to 6 hours. In other cases a special dilator tool, such as a Laminaria Stick (a small rod made with dried seaweed) can be used. The stick is inserted inside the cervix, where over a few hours the seaweed sucks in water, expanding and gently pushing the cervix apart. A small balloon tipped catheter tube called a Foley Catheter may also be used. Water is injected through the tube, irritating the uterus which prompts the cervix to dilate. All these procedures can be carried out at your obstetrician’s or midwife's offices.

Breaking Of Waters

Also known as Rupturing of Membranes (ROM), Artificial Rupture of Membranes (AROM) and Amniotomy. This procedure involves breaking the mother’s waters to kick-start contractions. Most women go into labor within hours of having their water broken. A doctor or midwife ruptures the amniotic sac with a small plastic hook, releasing a sudden gush of amniotic fluid. When the sac is ruptured, the body instantly produces more prostaglandin's which starts or increases uterine contractions. This procedure is usually carried out in hospital.

Stripping The Membranes

This procedure involves separating the amniotic sac from the wall of the uterus. This can only be carried out if the cervix is already dilated enough to admit the clinician’s gloved index finger. Inserting the finger, he places it between the cervix and membranes and rotates it to loosen the membranes. The membranes connect the amniotic sac to the wall of the uterus. Irritating the uterus can cause the body to release prostaglandin's and can cause contractions. You may experience slight cramping and spotting when the procedure is over. This procedure can be carried out in your doctor’s office (as well as hospital).

Oxytocin (Pitocin) - Drugs To Induce Labor

Usually applied via an intravenous drip (IV), Oxytocin (Pitocin) is only effective if cervix dilation is at least 3cm (some doctors say 4cm). When Oxytocin is used to induce labor, it can induce contractions and make them stronger. If labor has begun, the IV can be carried on for up to 8 or 10 hours. If Oxytocin does not take effect, it can be repeated on a different day, a process called serial induction. There should be close observation of any contractions and careful checking of the fetal heartbeat (fetal monitoring). The main danger of too much Pitocin, is that it can induce contractions so strong, they rupture the uterus and kill the baby. Induction of labor with Oxytocin should only be performed where it is considered more dangerous not to.

What Are Risks Are Involved?

• Premature Birth: Where a woman is not yet full-term, inducing early labor poses risks for the baby, including jaundice (yellowing of the skin and eyes) and difficulties in breathing.
• Lowered Blood Pressure: Where Pitocin is used, there is risk of lowering the fetal heart rate, which is why fetal monitoring is usually used.
• Medicated Delivery: It increases the risk of needing a C-section.
• Uterine Rupture: This risk is increased further if you had a previous C-section delivery.
• May Cause: Umbilical cord problems.

Related Articles on LABOR INDUCTION

For more about having a baby, see the following:

• How Do I Know If I'm In Labor?
• Home Births and Waterbirths

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