What is Labor Induction and How is it done?
What is Labor Induction?
Labor induction — also known as inducing labor — is the stimulation of uterine contractions during pregnancy before labor begins on its own to achieve a vaginal birth. A health care provider might recommend labor induction for various reasons, primarily when there’s concern for a mother’s health or a baby’s health. One of the most important factors in predicting the likelihood of a successful labor induction is how soft and distended your cervix is (cervical ripening).
The benefits of labor induction typically outweigh the risks. If you’re pregnant, understanding why and how labor induction is done can help you prepare.
Why is it done?
To determine if labor induction is necessary, your health care provider will evaluate several factors, including your health, your baby’s health, your baby’s gestational age, weight and size, your baby’s position in the uterus, and the status of your cervix. Reasons for labor induction include:
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Postterm pregnancy.
You’re approaching two weeks beyond your due date, and labor hasn’t started naturally.
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Premature rupture of membranes
Your water has broken, but labor hasn’t begun.
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Chorioamnionitis
You have an infection in your uterus.
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Fetal growth restriction
The estimated weight of your baby is less than 10 percent of what is expected for the gestational age.
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Oligohydramnios
There’s not enough amniotic fluid surrounding the baby.
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Gestational diabetes
You have diabetes that develops during pregnancy.
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High blood pressure disorders of pregnancy
You have a pregnancy complication characterized by high blood pressure and signs of damage to another organ system (preeclampsia), high blood pressure that was present before pregnancy or that occurs before 20 weeks of pregnancy (chronic high blood pressure), or high blood pressure that develops after 20 weeks of pregnancy (gestational hypertension).
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Placental abruption
Your placenta peels away from the inner wall of the uterus before delivery — either partially or completely.
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Certain medical conditions
You have a medical condition such as kidney disease or obesity.
What Could Be The Risks Of Labor Induction?
While not all labor-induced pregnancies are risky, some cases of labor induction could lead to:
- Postpartum hemorrhage:Prolonged labor or issues with labor induction method could result in heavy bleeding after delivery. There’s no need to worry as this happens rarely.
- Uterine rupture:Inducing labor using oxytocin and prostaglandins in a series of steps or not waiting for a certain time could cause uterine rupture.
- Decreased oxygen and blood supply to the baby:Frequent contractions or prolonged labor could decrease the oxygen and blood supply to the baby, putting it at risk. In rare cases, it may cause birth injuries.
- Others:Although rare, other risks could be infection to the mother or the baby and umbilical cord problems.
How does labor induction work?
If you do end up needing to be induced, the process involves a number of steps, though you usually won’t go through all of them:
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Cervical ripening
Usually your cervix will open up naturally on its own once you’re ready to go into labor. However if your cervix shows no signs of dilating and effacing (softening, opening, thinning) to allow your baby to leave the uterus and enter the birth canal, your practitioner will need to get the ripening rolling. She’ll usually do this by applying a topical form of the hormone prostaglandin (either a gel or a vaginal suppository) to your cervix. Your cervix will be checked after a few hours; often, this will be enough to get labor and contractions started. However if the prostaglandin is doing its work ripening the cervix but contractions haven’t started, the process continues on to the following steps.
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Membrane stripping
If your bag of waters (amniotic sac) is still intact, your practitioner may get labor started by swiping her finger across the fine membranes that connect the amniotic sac. This causes the uterus to release prostaglandin, just as it would if labor began naturally, which should in turn cause the cervix to soften and contractions to start. This process isn’t always pain-free, and while it isn’t meant to break your water it sometimes does.
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Rupturing the membrane
If your cervix has already begun to dilate and efface on its own but your water hasn’t broken, your practitioner might jump-start your contractions by artificially rupturing the membranes. In other words, she’ll break the bag of waters that surrounds your baby manually using an instrument that looks like a long crochet hook with a sharp tip. It might feel uncomfortable, but it shouldn’t be painful. This is one of the procedures that the new ACOG guidelines suggest may not be necessary in all women with low-risk pregnancies.
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Pitocin
If neither the prostaglandin gels nor the stripping or rupturing of the membranes has brought on regular contractions within a couple of hours, your practitioner will slowly give you the medication Pitocin (a synthetic form of the naturally-occurring hormone oxytocin) via an IV to induce or augment contractions. When Pitocin is used contractions — which usually start about 30 minutes later — are usually stronger, more regular and more frequent than those where labor has begun naturally (though if this is your first baby, you won’t have anything to compare it with). If you’re considering an epidural, you might want to ask your practitioner about getting it started while you’re getting the Pitocin so it’s in place once labor does start.
Are there any techniques I can try at home to get my labor going?
No do-it-yourself methods for starting labor have been proven consistently to be both safe and effective. Here’s the scoop on some of the techniques you may have heard about:
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Sexual intercourse:
Semen contains prostaglandins, and having an orgasm may stimulate contractions. A few studies have shown that having sex at term may reduce the need for labor induction, but others have found no effect on promoting labor.
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Nipple stimulation:
Stimulating your nipples releases oxytocin and may help start labor. While it’s a time-honored approach, more research is needed to determine how effective it is. And because there’s a possibility of overstimulating your uterus (and stressing your baby), it’s not safe to try without your provider’s supervision.
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Castor oil:
Castor oil is a strong laxative. Although stimulating your bowels may cause some contractions, there’s no definitive proof that it helps induce labor – and you’re likely to find the effect very unpleasant. It can also lead to diarrhea and dehydration.
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Herbal remedies:
A variety of herbs are touted as useful for labor induction, but there isn’t enough evidence to prove that any of them are safe or effective. Some are actually risky because they can overstimulate your uterus and also may be dangerous to your baby for other reasons.
Before trying anything that might induce labor, you’ll want to speak with your doctor to go over any risks or possible complications. Though some of these methods are popular folklore among pregnant women, little scientific evidence supports their efficacy.
In most cases, labor induction leads to a successful vaginal birth. In case the labor induction fails, you might need to try another induction or have a C-section.
If you have a successful vaginal delivery after induction, there might be no implications for future pregnancies. If the induction leads to a C-section, your health care provider can help you decide whether to attempt a vaginal delivery with a subsequent pregnancy or to schedule a repeat C-section.
Also read: Vacuum-Assisted Delivery: What is it?
