What is Induction of Labor?
Inducing labor pains for childbirth using artificial methods is known as induction of labor. This is performed when the women fail to have natural labor or it is imperative to birth the child before the due date due to some problem. Even though the process of induction of labor is used for people who have a problem in going through normal delivery, it is nowadays used by women for their own convenience due to work related problems or if their home is too far away from the hospital etc.
Induction of labor has become quite a common procedure in this modern age and 25% of women in the United States of America opt for induced labor. But according to the American College of Obstetricians and Gynecologists (ACOG), induction of labor should only be done if no other option is available and it becomes very dangerous for the baby to remain inside the womb; otherwise you should let nature take its course.
Medical Reasons for Induction of Labor
Post-term pregnancy means you are past your due date of birth. If you are a week or two past your due date, your doctor may advise you to opt for induction of labor as there is an increased risk of complications to you and your baby if you have not given birth even after 41st week of pregnancy. One such complication is the decreased supply of nutrients to the baby due to decreased effectiveness of placenta.
No Labor Even After Your Water Breaks
Induction of labor is also done if your labor has not started even after your water breaks which is actually the rupture of amniotic sac. Even though it is still safe to wait for 24 to 48 hours for natural labor to begin and in most cases it usually begins in that amount of time. In very few cases though, labor does not start naturally even after 2 days and when that happens, it is not safe to wait any more as there is an increased risk of infection to your baby after your water breaks and you should go for induction of labor.
Intrauterine Growth Restriction
IUGR or Intrauterine growth restriction is a condition in which there is poor development of the baby in the uterus mostly due to lack of nutrition. If such is the case then also your doctor can induce labor.
If the mother has some health problems that might put the baby at a higher risk, such as diabetes, high blood pressure or hypertension, preeclampsia or eclampsia, then your doctors may opt for induction of labor.
History of Stillbirth
If you have a previous history of stillbirth or in-utero death of the fetus, then also your doctor might not want to wait for natural labor and instead opt for induction of labor. Induction of labor is usually done for medical termination of pregnancy or abortion as well.
This is a condition in which there is very little amniotic fluid surrounding the baby in the amniotic sac which interferes with the proper growth and nutrition of the baby. If such is the case, the doctors may advise you to go for induction of labor.
Methods Used for Induction of Labor
There are many methods used for induction of labor. Sometimes doctors also use a combination of these methods. It may take a day or two for your labor to start after you have had your induction of labor, if your cervix is not ripened enough or if you only need a little assistance, you may give birth to the baby in a matter of hours after your induction of labor.
Ripened cervix means that your cervix has already dilated and thinned out which basically means you are ready for the birth of the baby but if it is not the case with your cervix then that is termed as "unripe" cervix. Following are some of the methods used for induction of labor:
Artificial Rupture of Membranes
In this process, your doctor artificially breaks your water by rupturing your amniotic membranes which is a method used for induction of labor. For this purpose a plastic thin hook is used to make a small hole in the amniotic sac and the fluid flows out of it. The procedure is called amniotomy. Your baby's heart rate is monitored throughout the procedure, usually the labor starts after rupturing of membranes and the doctors also examine the fluid to look for meconium which is the first excreta of the baby. The presence of a lot of meconium in the fluid indicates that the baby is distressed.
Medications Used For Induction of Labor
Medications are also given for induction of labor. Usually two different medicines are used for induction of labor. They are as follows:
Prostaglandins are hormones which are given to women who have an unripe cervix for induction of labor. They can be taken orally or can be placed inside the vagina. It helps in ripening your cervix and sometimes triggers your contractions as well. It is usually administered in the hospital but you are free to move around the room. The heart rate of the baby is monitored initially during this method of induction of labor.
Oxytocin is a hormone which is released by the body naturally during childbirth to induce contractions. Their synthetic counterparts are given to women for induction of labor. Pitocin and Syntocinon are two commercial names of the hormones. They are administered intravenously in low doses. They induce contractions for childbirth.
Use of Foley Catheter or Cervical Ripening Balloon
In this method of induction of labor, a thin tube with balloon is inserted in the cervix and then filled with water which inflates the balloon. This causes your cervix to dilate and also stimulates the release of prostaglandins and further ripens and softens your cervix. This can also cause the onset of contractions.
Stripping or Sweeping of Membranes
This method is usually used if your cervix is already partially dilated. In this method, a gloved finger in inserted inside your cervix to separate the amniotic membranes from the lower part of your uterus. As a result of that prostaglandins are released which further help in induction of labor by ripening the cervix. The process can be uncomfortable or even painful but this discomfort is usually short-lived.
Risks Associated With Induction of Labor
As with any other procedure there are risks associated with induction of labor as well. Some of these risks are as follows:
Increased Risk of C-Section
Some studies show that opting for induction of labor before 41st week of pregnancy without any medical reason will lead to a greater risk of caesarian section. If induction of labor fails to produce contractions, your doctor will perform a C-section.
Increased Use of Pain Medications
Induction of labor increases the need for pain medications such as an epidural or other medications as usually after induction of labor, contractions are stronger and far closer to each other than they would otherwise be, if the labor was natural.
Increased Risk of Complications During Birth
Induction of labor may also cause various complications during birth such as placental abruption (detachment of placenta from the wall of the uterus) or uterine rupture (a tear in the wall of the uterus). These complications are more likely to happen in women who are attempting a vaginal birth after a caesarian or some other uterine surgery. Doctors believe that in such women induction of labor should not be done using prostaglandins or oxytocin.
Health Problems for the Baby
Babies are likely to have some health problems such as abnormal breathing and developmental problems in women who have had induced labor. This is because babies are usually born early (between 37 to 39 weeks) in women who are induced.
Increased Risk of Infection
Rupture of the amniotic sac earlier can lead to infections as amniotic sac protects the baby from these infections. So, induction of labor by artificial rupture of membranes can also lead to this problem.
Bleeding After Delivery
There is also a chance that your uterine muscles may not contract properly after delivery which is termed uterine atony and this can lead to heavy bleeding after delivery which could have some serious consequences.
Circumstances When Induction of Labor Should Not Be Done
There are some circumstances in which induction of labor should not be done such as:
- If you have placenta previa. If you have this condition your placenta is placed very low in your uterus, covering or next to your cervix.
- If your baby's head is not facing your cervix then this means that he or she will not come headfirst. This position of the baby is called breech or transverse position.
- If you have had a caesarian baby before by vertical uterine incision or some other uterine surgery, induction of labor can be very dangerous.
- If you have a genital herpes infection or any other such serious infection, you should not opt for induction of labor.
- If your birth canal is very small and it cannot be used for normal labor and birth, then also you are not induced for labor.
- You should not have induction of labor, if you are having triplets or more or if you are having twins but one of them is in transverse position.
- If it is imperative that your baby should be delivered immediately or if he cannot tolerate contractions, then also you need to have a C-section and not induction of labor.
DIY Techniques for Induction of Labor
There are a few techniques that you can try at home to induce labor if you are past your due date. Not all of these techniques have proven results but if you do it after talking to your doctor, you should be safe enough. Some of these are given here:
Few studies have shown that having sex at term reduces the chances of induction of labor. This is because semen contains prostaglandins and female orgasms can help in triggering contractions.
Stimulation of nipples releases oxytocin which can help in triggering contractions. Even though the extent of its effectiveness is unknown and there is also a possibility of overstimulating your uterus and therefore, stressing your baby, it has been used to induce labor for a very long time. You should ask your doctor though, before practicing nipple stimulation.
Herbal remedies such as black or blue cohosh and evening primrose oil are also said to be effective for induction of labor though there is no scientific proof of this. Besides some of these can be quite dangerous in certain conditions, so you should definitely ask your doctor before using them.
Castor oil is also one of those things which have been in use for a long time. It is a strong laxative and stimulates bowel movement which can lead to contractions but its effect is again not proven. It can cause diarrhea and dehydration and it can also lead to nausea and vomiting.
Walking is also helpful in inducing contractions not to mention it keeps you fit. Walking when you are at term can help in induction of labor but if you experience discomfort such as high blood pressure or abnormally fast breathing, you should consult your doctor.
So these are some of the techniques that you can try at home beforehand to reduce the chances of induction of labor.
This is all the information that you will likely need if you are opting for induction of labor. You should talk to your doctor and if necessary, ask them to explain everything in detail including all the risks and dangers that you are likely to encounter. Don't be hesitant and nervous in asking questions as it is your right as a patient to ask questions. Be confident and make an informed decision.