Induction of labor is a process to start labor artificially. During pregnancy your baby is surrounded by a fluid filled sac which protects the baby while he or she is developing in the womb. This fluid inside the sac is called amniotic fluid. In preparation for labor the cervix softens and shortens. This is called "ripening of the cervix". Before or during labor the membranes break, releasing the fluid which is called "breaking of your waters ". During labor the cervix opens and the uterus contracts to push your baby out. In most pregnancies labor starts naturally between 37 and 42 weeks, leading to the birth of the baby.
When and why
When it is felt that your or your baby's health is likely to benefit, or continuing the pregnancy is harmful to the mother or baby, your doctor may offer and recommend induction of labor. On average about 20 percent of labors are induced.
There are a number of reasons why induction may be recommended. For example if you have diabetes or high blood pressure.
If you are healthy and have had a problem-free pregnancy, induction of labor may be offered if:
your pregnancy is more than 41 weeks
your waters break before labor starts
- explaining the procedures
-care during induction
-any risks to you or your baby.
If you have had a previous cesarean section or have had more than five babies induction may be offered with caution.
If your pregnancy is more than 41 weeks
An ultrasound scan in early pregnancy i.e.18 weeks can help to determine your baby's due date more accurately. This reduces your chances of unnecessary induction. Even if you have had a trouble free pregnancy, you should be offered induction of labor after 41 weeks because from this stage the risk of your baby developing problems increases. An induction because you are overdue does not increase the chance of you needing a cesarean section.
If you choose not to be induced at this stage then from 42nd week you should be offered:
Twice weekly checks of your baby's heartbeat using an electronic fetal heart rate monitor. (CTG)
A single ultrasound test to check the depth of amniotic fluid (or "waters") surrounding your baby. (AFI)
If your waters break before labor starts
Sometimes a your waters break before labor starts. This happens in 5 percent of pregnancies and is known as prelabor rupture of the membranes (PROM). When this happens, ninety percent of time you will go into labor naturally within 24 hours. The longer the time between PROM and the birth of your baby, the higher the risk of infection to you or your baby.
If you are more than 37 weeks pregnant and your waters have broken but you have not gone into labor you should be offered the choice of either:
Induction of labor
A "wait and see approach" to see if labor will start naturally
As a ‘wait and see approach’ carries risk of infection, you will need to:
check your temperature twice a day
check for changes in the color or odor of your amniotic fluid ("waters")
check for any other signs of fever such as shivers or flushing
If you have not gone into labor after 24 hours, induction is strongly recommended.
If your waters break before you go into labor, your chances of having a cesarean section will not be increased by choosing either induction or "wait and see".
How
There are a various methods that can be used to induce your labor.
Membrane sweeping
Membrane sweeping has been shown to increase the chances of labor starting naturally within the next 48 hours .This reduces the need for other methods of induction of labor.
Membrane sweeping involves your doctor placing a finger just inside your cervix and making a circular, sweeping movement to separate the membranes from the cervix. It can be carried out at an outpatient appointment or in hospital. The procedure may cause some discomfort or mild bleeding, but will not cause any harm to your baby and it will not increase the chance of you or your baby getting an infection. Membrane sweeping is not done if your waters have broken.
Using prostaglandins
Prostaglandins are medicine that help to induce labor by encouraging the cervix to soften and ripen. This allows the cervix to open and contractions to start. Prostaglandins are normally given as a tablet or gel that is inserted into the vagina. This is usually done in hospital in an ante-natal ward. More than one dose may be needed to induce labor. Doses should only be given every six to eight hours.If your membranes have not yet ruptured (waters broken) prostaglandins are the recommended method of induction. This is the case whether this is your first pregnancy or not, and whether or not your cervix has ripened. Before giving prostaglandins your midwife or doctor should check your baby's heart beat. After being given prostaglandins you should lie down for at least thirty minutes. Once your contractions start your midwife or doctor should monitor your baby's heartbeat using a "CTG". Once it is established that everything is okay, the CTG should be discontinued and you will be able to move around. There is no evidence to suggest that labor induced with prostaglandins is any more painful than labor that has started naturally. However prostaglandins sometimes cause vaginal soreness. Very occasionally prostaglandins can cause the uterus to contract too much which may affect the pattern of your baby's heartbeat. If this happens you should be asked to lie on your left side. You may be given other medication to help relax the uterus and any prostaglandin tablet or gel remaining in your vagina may be removed.
Using Oxytocin
Oxytocin is given in hospital in the delivery room. This is a drug that encourages contractions. Oxytocin is given through a drip and enters the blood through a tiny tube into a vein in the arm. Once contractions have begun, the rate of the drip will be adjusted so that your contractions occur regularly until your baby is born. If your waters have broken prostaglandins and oxytocin are shown to be equally effective methods of inducing labor. This is the case whether this is your first pregnancy or not, and whether or not your cervix has ripened.
While being given the oxytocin the or doctor should monitor your baby's heartbeat continuously. If your waters have not broken, a procedure called an amniotomy is be recommended. This is when your or doctor makes a hole in your membrane to release the waters. This procedure is done through your vagina and cervix using a small instrument. This will cause no harm to your baby, but the vaginal examination needed to perform this procedure may cause you some discomfort.
Women who have oxytcin are more likely to have an epidural to help with pain. An epidural is a pain relief injection given into your back. Oxytocin is given by a drip and being attached to this will limit your ability to move around. Whilit may be okay to stand up or sit down, it will not be possible to have a bath or move from room to room.
Very occasionally oxytocin can cause the uterus to contract too much which may affect the pattern of your baby's heartbeat. If this happens you should be asked to lie on your left hand side and the drip will be turned down or off to lessen the contractions. Sometimes another drug will be given to counteract the oxytocin and lessen the contractions.
If you have already had prostaglandins, oxytocin should not usually be given for at least six hours. Your doctor should fully discuss these options with you before any decision is reached. They should explain the procedures and care that will be involved and whether there are any risks to you or your baby.
