Inducing Labor

 

inducing laborInducing labor is the artificial start of the birth process through medical interventions or other methods. Induction not done for medical reasons or as an emergency is considered elective. Induction of labor has recently been on the rise for purposes of convenience or to accommodate busy schedules.  However, according to the American College of Obstetricians and Gynecologists (ACOG), labor should be induced only when it is more risky for the baby to remain inside the mother’s uterus than to be born.

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What are some medical reasons for inducing labor?

Labor is likely to be induced:

  • When a complication develops such as: hypertension, preeclampsia, heart disease, gestational diabetes, or bleeding during pregnancy.
  • If the baby is in danger of not getting enough nutrients and oxygen from the placenta.
  • The amniotic sac has ruptured but labor hasn’t started within 24-48 hours.
  • The pregnancy is prolonged beyond 42 weeks with possible risk to the baby from a gradual decrease in the supply of nutrients from the placenta.
  • There is an infection inside the uterus known as chorioamnionitis.

How is labor induced?

Labor can be induced by the following methods:

1. Medications:

Prostaglandin: Suppositories are inserted into the vagina during the evening causing the uterus to go into labor by morning.  One advantage to this method is that the mother is free to move around the labor room.

Oxytocin: The body naturally produces the hormone oxytocin to stimulate contractions. Pitocin and Syntocinon are brand name medications that are forms of oxytocin that can be given through an IV at low doses to stimulate contractions.

What are the advantages of taking oxytocin? Oxytocin can initiate labor which might not have started on its own and it can speed up the pace of labor.

What are the concerns when taking oxytocin? Labor can progress too quickly, causing contractions to become difficult to manage without pain medication. Oxytocin may need to be discontinued if contractions become too powerful and close together.

2. Artificial rupture of the membranes (AROM): When the bag of water (amniotic sac) breaks or ruptures, production of the hormone prostaglandin increases, speeding up contractions. Some health care providers might suggest rupturing the amniotic membrane artificially. A sterile, plastic, thin hook is brushed against the membranes just inside the cervix causing the baby’s head to move down against the cervix, which usually causes the contractions to become stronger. This procedure releases a gush of warm amniotic fluid from the vagina.

What are the Advantages of artificial rupture of the membranes?

  • Labor may be shortened by an hour.
  • The procedure allows the amniotic fluid to be examined for the presence of meconium, which may be a sign of fetal distress.
  • The heart rate can be monitored with direct access to the baby’s scalp.

What are the Disadvantages of artificial rupture of the membranes?

  • The baby may turn to a breech position, making birth more difficult if the membranes are ruptured before the baby’s head is engaged.
  • It is possible for the umbilical cord to slip out first (prolapsed cord).
  • Infection can occur if there is too much time between rupture and birth

3. Natural: Nipple Stimulation is a natural form of labor induction that can be done manually or with an electric breastfeeding pump. The hormone oxytocin will naturally be produced to cause contractions. The concept is the same as when a baby nurses right after birth, stimulating contractions, which slows bleeding.

What expectations should I have about induced labor?

  • You can still do breathing exercises and push at your own pace if you prefer to avoid pain medications throughout the delivery.
  • You can also request an epidural anesthetic or some other form of pain relief if needed.

The following questions can be helpful when you do not understand or feel comfortable with suggested interventions:

  • Why do I need this procedure?
  • How will it help me and my baby?
  • Are other options available? If so, what are they? What are the risks?
  • What are the risks if the procedure isn’t done?
  • What are the risks of delaying the intervention for an hour?
Last Updated: 01/2014

Compiled using information from the following sources:

Mayo Clinic Guide To A Healthy Pregnancy.  Harms, Roger W., M.D., et al, Part 4.

Planning Your Pregnancy and Birth Third Ed. The American College of Obstetricians and Gynecologists, Ch. 8.

Lamaze International, http://www.lamaze.org/