As you reach the end of your term, the cervix normally becomes soft, begins to dilate and efface and prepares for labor and delivery. Labor starts with regular, frequent and eventually intense contractions. However, this will not happen in all pregnancies. Sometimes labor starts but progresses very slowly and in some situations, the labor does not start naturally, this is when the significance of labor induction and labor augmentation comes into picture. Nowadays, labor induction and augmentation are very common and many pregnant women prefer to do it even for non-medical reasons such as if they have passed their due date without any signs of labor, to finish the delivery as fast as possible etc. However, remember, both labor induction and augmentation are procedures that compel the body to do something it is not yet set to do. Moreover, both procedures have its own risk factors. Continue reading to explore everything you need to know about these two procedures.
What Is Labor Induction?
When your body is preparing for a natural process of delivery, it starts sending signals to the brain to produce more oxytocin in order to start uterine contractions. The pelvic muscles and uterine wall respond by increasing the frequency and intensity of contractions. This is known as labor. In most cases, active labor will start on its own. After feeling frequent contractions at regular intervals, your cervix will start dilating and preparing for delivery. In pregnancies where the labor may not start on its own but vaginal delivery needs to happen soon, labor has to be induced artificially. This is called labor induction.
When Is Labor Induced?
The most common reasons when the doctor decides to induce labor are:
- Overdue pregnancy: This is the most common reason for the labor induction. A pregnancy is considered as post-term or overdue when it advances beyond 42 weeks. Overdue pregnancy is associated with fetal, neonatal, and maternal complications. Labor induction is an option in such cases
- Health condition of mother: If the mother has health issues such as high blood pressure, placenta abruption, preeclampsia, any infection, pulmonary issues or gestational diabetes, which may put the mother or baby at risk, the doctor may decide to induce labor to avoid any further health complications
- Previous history of precipitous labor: Labor is counted as “fast” or “precipitous” when the whole procedure of labor and delivery lasts three hours or less. Doctors recommend induction for mothers with a history of precipitous labor to ensure the baby comes out in the right place at the right time, thereby reducing the complications that can occur due to precipitous labor
- Premature rupture of membrane (PROM): When the amniotic sac or water breaks and the fluid start to leak before the labor begins, it is called premature rupture of membrane. If there are no other complications, the doctor will wait for 12 to 24 hours (maximum) for the labor to begin and then decide to induce labor
- Intrauterine growth restriction: IUGR refers to a condition in which the baby is smaller than it should be because it is not growing at a normal rate inside the womb. Delayed growth in babies can lead to various health conditions. So if the baby is in urgent need of medical assistance, and the chance of vaginal delivery is less, labor is induced couple of weeks before the due date
- Intrauterine fetal demise: If the baby dies in the uterus any time after the 20th week of gestation it is called intrauterine fetal demise. Labor is induced in such cases to take the fetus out of the womb
- Oligohydramnios: If the pregnant woman is experiencing Oligohydramnios, a condition characterized by low level of amniotic fluid, the common practice is to induce the labor before the due date
How Is Labor Induced?
There are several methods to induce labor. However, the first step is to examine the cervix to see if it is favorable i.e. if it is slightly opened or dilated, or unfavorable i.e. it remains tightly closed.
- In case of favorable cervix:
- Stretch and sweep: In this method, no drugs are used. The doctor induces labor during a vaginal exam. He inserts his gloved fingers between the partially dilated cervix and the amniotic sac and loosens the sac from the uterine wall
- Artificial rupture of membrane: After stretching the cervix if the baby’s head is well engaged, the next step is the artificial rupture of the membrane (ARM). For this, a special plastic hook is put inside the dilated cervix making a small tear in the amniotic membranes. This will initiate contractions. However, if contractions don’t start after a couple of hours, other methods of induction will be tried
- In case of unfavorable cervix:
- Cervical ripening: There are several methods to soften and dilate the firmly closed cervix. The procedure is collectively called cervical ripening. Here are some artificial hormones and medicines used for cervical ripening:
- Prostaglandins/ Dinoprostone: This is a lipid compound having a hormone-like effect. This drug, which is available in both gel form and pessary, in inserted inside the vagina. It will help to soften, efface and dilate the cervix and start contractions
- Misoprostol: These pills are used to treat ulcers. The unlabeled use of this medicine is widely used to dilate the cervix and induce labor. They can either be taken orally or inserted in the vagina
- Balloon catheterization: Balloon catheter is a soft, silicon, narrow tube with two small balloons at the end. In balloon catheterization, the catheter is inserted into the cervix and balloons are inflated. The balloons put consistent (gentle) pressure on the cervix, making it soft and cervix begins to efface, dilate and expand. The balloon catheter will drop out on its own as the cervix opens up
- Synthetic oxytocin (Pitocin) to induce contractions: Once the cervix becomes favorable, synthetic oxytocin (Pitocin) is administered through an IV drip. This hormone prompts uterine contraction. The contractions and baby’s heartbeat are monitored throughout the procedure. Usually, synthetic oxytocin is administered in small amount and then eventually increased based on the frequency and intensity of contractions
Mostly labor induction results in vaginal birth. However, if it fails C-section is scheduled.
When Is labor Not Induced?
Inducing the labor is not considered as an option and the doctor straight away goes for a C-section if:
- The pelvis of the pregnant woman is not favorable for a vaginal delivery as the birth canal is too small compared to the size of baby
- If the fetal position is not favoring a vaginal delivery. If the baby is not in head first position but is in transverse or breech position, inducing labor is avoided
- Placental complication like placenta previa makes vaginal delivery impossible and hence the doctor goes for C-section
- If the mother has previously undergone surgical procedures like C- section with a vertical incision and significant uterine surgery like fibroid removal surgery, labor induction is avoided because of increased risk of uterine rupture
- If the baby is not healthy enough to tolerate the pressure of contractions
- Multiple pregnancies, especially if the first baby is not in headfirst position
- If the pregnant woman has active genital herpes infection, vaginal delivery is avoided as the virus will be present in the birth canal
- If the mother has a history of uterine rupture
Risks Associated With Labor Induction
In most cases inducing labor is perfectly safe but like everything it does have a few risks involved. Some of the complications associated with labor induction are:
- Uterine rupture: The contractions in artificially induced labor can be abnormally frequent, strong, and long. This can be result in uterine rupture (especially if attempting VBAC) and placental abruption
- Increased chances of assisted delivery: More often during induced delivery, even if the baby is head first, the babies tend to stay in unfavorable position. This increases the chances of assisted vaginal delivery and requires using forceps or vacuum extraction for the delivery and can be risky for both mother and the baby
- Increased chances of a C-section: Even after labor is induced and contractions does not take place, the doctors have no option but to go in for a C-section as the risk of infection increases for both mother and the baby
- Premature baby: The babies delivered through labor induction are obviously not yet ready to be born. This means that their organs, especially the respiratory system may not be fully functional as the lungs will be still immature. Likewise, they are more prone to jaundice. More often, the baby will be admitted to the NICU (neonatal intensive care unit)
- Low fetal heart rate: The medicines used to induce labor may result excessive contractions, which in turn can decrease the child’s oxygen supply and lower baby’s heart rate
- Postpartum bleeding: After an induced delivery the uterine muscles tend to remain relaxed instead of contracting significantly. This increases the chances of intensive bleeding after delivery
- Umbilical cord prolapse: Inducing labor increases the chances of umbilical cord prolapse
What Is Labor Augmentation?
In some pregnancies, the labor, though starts on its own, will not progress or the contractions may not be frequent and forceful enough to dilate the cervix and move the baby through the birth canal or if the contractions stop mid labor, then the doctor may intervene and try to stimulate the contractions. This intervention done on purpose to increase the intensity of contractions and help the labor progress smoothly through delivery is called labor augmentation.
Why Is Labor Augmented?
Even if you are in active labor, your labor may be augmented due to any of the following reasons:
- Your water has not yet broken
- Your contractions are not frequent and forceful or may have stopped altogether
- Your water has broken yet your labor is not progressing
How Is Labor Augmented?
Labor can be augmented by both natural therapy and medical interventions. Some of the ways of labor augmentation are:
- Mechanical like stretch and sweep and artificial rupture of the membrane
- Medication like inserting synthetic hormones like Pitocin and other medicines in the vagina, administrating them intravenously or orally
- By stimulating your nipples
What Are The Risks Associated With Labor Augmentation?
The risk are more or less similar to the risk associated with labor induction. Only thing is that, as the labor starts on its own, the baby in most cases is not a preemie.
If you are in any kind of doubt regarding your labor and delivery or if you are nearing your due date and anxious about the process of delivery, it is always better to have a clear and hearty chat with your doctor.