Induced Labor : Why, What and How

Should I Wait For Natural Labor To Start?

A wait-and-watch approach should be adopted up to two weeks post your due date. It is the law of nature to prepare the cervix on its own for the start of labor pains and easy passage of the fetus. However, if your doctor thinks that the life and safety of either the mother or the fetus are under question, you can be induced into labor.

The process of natural onset of labor involves the following:

• Uterine contractions every 10 minutes or even more frequently
• Changes in discharge from the vagina
• Increase in pelvic pressure
• Dull, low backache
• Abdominal cramps
• Vaginal spotting or discharge

Why Should I Have Induced Labor?

Induction of labor is recommended when the onset of natural labor is delayed or when there is a threat to the survival of the baby or the mother. Some common conditions requiring labor induction are:

• If your pregnancy continues past 40 weeks and there is no sign of the onset of labor. In postdated pregnancies, the placenta becomes incapable of meeting the nutritional needs of the fetus. There is also a higher risk of stillbirth if you do not go into labor after 40 weeks of pregnancy. Labor is also induced if you are pregnant two weeks past your due date without going into natural labor.
• The amniotic sac breaks (water breaks) 24 hours earlier and the natural labor pains have not started. This increases the risk of ascent of infection in the uterus. The presence of scanty amniotic fluid is another reason to induce labor.
• If the expectant mother has preeclampsia. This condition is characterized by the presence of blood pressure of more than 130/90 mm of hg and proteins in urine. Preeclampsia is a serious health hazard and hampers the blood flow to the baby.
• Presence of any maternal illness such as diabetes, high blood pressure, kidney disorder, etc.
• You are 40 years or older and/or have had a previous stillbirth.
• Personal reasons, like your husband would miss the birth if delayed.
• IUGR or Intrauterine fetal growth restriction, means that your baby is not growing anymore.
• You have a twin pregnancy extending beyond 38 weeks.

How Can I Induce Labor Naturally?

Here are some easy-to-do inducing methods that are quite popular, though they lack scientific backing. Though they appear to be safe still consult your doctor before attempting any of these:

• Sexual intercourse: Prostaglandins are found in semen so some doctors believe that having sex at the term may initiate the onset of labor pains. However, it is yet to be scientifically proven. Sex will not hurt, but if your water has broken, you run a high risk for infection
• Nipple stimulation:: Another popular belief is that oxytocin is released by nipple stimulation and this can further precipitate labor pains. However, research is yet to prove its efficacy and veracity
• Castor oil:: Being laxative castor oil is believed to initiate uterine contractions. Its use can also cause diarrhea and even dehydration. Never submit yourself to hearsay and take the advice of your doctor

How Is Labor Induced?

Here are some common and extensively used methods of inducing labor and cervical ripening in expectant mothers:

• Stripping or sweeping the membranes: If the cervix is dilated, the doctor can manually separate the sac of amniotic fluid from the lower uterine segment with the aid of gloved fingers. This sweeping of membranes causes the release of prostaglandins and the ripening of the cervix.
• Using prostaglandins: Prostaglandins are used to stimulate the dilatation and thinning out of the cervix. Prostaglandin tablets are inserted high up in the vagina. The cervix dilates and sometimes uterine contractions also set in
• Rupturing the membranes: Called Artificial rupture of the membranes or ARMS, it translates into breaking the waters. Manual rupture of membranes is also an effective method of labor induction. Your caregiver will break the amniotic sac with a sterile hooked instrument. This process is termed as ‘amniotomy’.
  The breaking of the ‘bag of water’ expedites the process of delivery of the baby.
• Using a Foley catheter: The insertion of Foley’s catheter in the vagina also facilitates the ripening of the cervix. Extra-amniotic saline infusion is used for inflating the balloon. The inflated balloon of the catheter exerts pressure on the cervix and encourages the release of natural prostaglandins which further results in dilatation and ripening of the cervix.
• Mifepristone: Mifepristone is also used for inducing labor, but its use is limited.
• Using oxytocin (Pitocin): Oxytocin or pitocin is also given via intravenous infusion to initiate or augment uterine contractions. The dose of the infusion can be adjusted according to the progress of labor.

Are There Any Risks With Induced Labor?

The risks associated with labor induction are enlisted as under:

• C-section: It is seen that labor induction generally results in a cesarean section, particularly if the cervix has not started to become soft and dilate or began to thin out. This risk is increased if the expectant mother has not delivered previously
• Premature birth: Induced labor is also associated with the risk of premature birth. Premature babies face breathing difficulties and require tremendous care
• Low heart rate: Induction of labor can also decrease the normal heart rate of the baby because the medicines used for inducing labor (oxytocin or prostaglandin) can adversely affect the oxygen supply to the baby thus diminishing the heart rate
• Infections: Some labor induction methods such as sweeping the membranes, placing seaweed rods or balloon catheters, breaking water, etc., aggravate the threat of infection that can affect the wellness of both the mother and the baby
• Umbilical cord problems: Labor induction also poses a risk of slipping of the umbilical cord into the vagina prior to the birth of the baby. This may cause cord compression and hamper the oxygen supply to the baby
• Rupture of the uterus: This is a rare risk where the uterine wall ruptures and the fetus enters the abdominal cavity. The condition is common in females having a scarred uterus (due to previous surgeries). In such a situation, an emergency C-section is the only life-saving option
• Post-delivery bleeding: Induction of labor can also pose of threat to your uterine musculature and can result in profuse bleeding after the delivery of the baby

How Can I Prepare Myself For Inducing Labor?

Depending on how dilated and soft your cervix is, your doctor will discuss the option of inducing labor. He will walk you through the processes that he deems fit for you. Though you can decline not going into induced labor, it is the safety of the baby and you that will be taken into priority.

Induced contractions are intense and stronger than normal contractions, so you should discuss pain relief methods with your doctor. Though it could be psychologically testing for you and your partner to wait for labor, always keep in mind that a healthy you and a healthy baby is all that matters.

FAQs

1. How Long Does Labor Take When Induced?

The process of inducing labor can vary in duration, ranging from several hours to up to 2-3 days. The efficacy of the treatment is contingent upon the individual response of your body. If this is your first pregnancy or you are at the gestational age of less than 37 weeks, it is probable that the duration of the process may be prolonged.

2. What Is Better Induction or C-Section?

According to research, the induction of labor one or two weeks prior to the due date decreases the likelihood of requiring a cesarean delivery. Furthermore, it is advantageous for the well-being of both the mother and the infant. In the event that induction of labor has been recommended for a particular reason, but the patient declines, they may elect to await the onset of spontaneous labor or opt for cesarean delivery. It is recommended that you consult with your health care provider at the earliest opportunity to learn about the available options.

3. Is Inducing Labor Safe For The Baby?

This is not always the case. The drugs used for kicking off labor, namely oxytocin or prostaglandin, may result in atypical or heightened uterine contractions, leading to compromised fetal oxygenation and decreased fetal heart rate.

4. Is induced Labor Faster Than Normal Labor?

The duration of inductions can vary significantly, ranging from a few hours to several days. Therefore, undergoing induction does not necessarily indicate that an individual is on a fast track. The fundamental difference between labor that occurs spontaneously and that which is induced is the degree of intensity of the contractions. It is commonly observed that induced labor is more painful than natural labor, although it is not necessarily faster.