Different methods of induction
Inducing Labor (for Parents) - Nemours KidsHealth
It's common for many pregnant women, especially first-time mothers, to watch their baby's due date come and go without so much as a contraction. The farther away from the expected delivery date (called the EDD) you get, the more anxious you might become. You may start to wonder — is this baby ever going to come?
Late pregnancy can be challenging — you may feel large all over, your feet and back might hurt, you might not have the energy to do much of anything, and you're beyond ready to meet the little one you've nurtured all this time. Which is why waiting a little longer than you'd expected can be particularly hard.
Still, being past your due date doesn't guarantee that your doctor (or other health care provider) will do anything to induce (or artificially start) labor — at least not right away.
What Is It?
Labor induction is what doctors use to try to help labor along using medications or other medical techniques. Years ago, some doctors routinely induced labor. But now it's not usually done unless there's a true medical need for it. Labor is usually allowed to take its natural course. However, in some situations, a health care provider may recommend induction.
Why It's Done
Your doctor might suggest an induction if:
- your water broke but you are not having contractions
- your baby still hasn't arrived by 2 weeks after the due date (when you're considered post-term — more than 42 weeks into your pregnancy)
- you have an infection in the uterus (called chorioamnionitis)
- you have certain risk factors (e.g., gestational diabetes or high blood pressure)
- there is not enough amniotic fluid
- there is a problem with the placenta
- the baby is not growing appropriately
Induction also can be appropriate under certain circumstances, as with a mother who is full term and has a history of rapid deliveries or lives far from a hospital.
Some mothers request elective inductions for convenience, but these do come with risks. Doctors try to avoid inducing labor early because the due date may be wrong and/or the woman's cervix might not be ready yet.
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How It's Done
Some methods of induction are less invasive and carry fewer risks than others. Ways that doctors may try to induce labor by getting contractions started include:
- Stripping the membranes. The doctor puts on a glove and inserts a finger into the vagina and through the cervix (the opening that connects the vagina to the uterus). He or she moves the finger back and forth to separate the thin membrane connecting the amniotic sac (which houses the baby and amniotic fluid) to the wall of the uterus. When the membranes are stripped, the body releases hormones called prostaglandins, which help prepare the cervix for delivery and may bring on contractions. This method works for some women, but not all.
- Breaking your water (also called an amniotomy).
The doctor ruptures the amniotic sac during a vaginal exam using a little plastic hook to break the membranes. If the cervix is ready for labor, amniotomy usually brings on labor in a matter of hours. - Giving the hormone prostaglandin to help ripen the cervix. A gel or vaginal insert of prostaglandin is inserted into the vagina or a tablet is given by mouth. This is typically done overnight in the hospital to make the cervix "ripe" (soft, thinned out) for delivery. Administered alone, prostaglandin may induce labor or may be used before giving oxytocin.
- Giving the hormone oxytocin to stimulate contractions. Given continuously through an IV, the drug (Pitocin) is started in a small dose and then increased until labor is progressing well. After it's administered, the fetus and uterus need to be closely monitored. Oxytocin is also frequently used to spur labor that's going slowly or has stalled.
What Will It Feel Like?
Stripping the membranes can be a little painful or uncomfortable, although it usually only takes a minute or so.
You may also have some intense cramps and spotting for the next day or two.
It can also be a little uncomfortable to have your water broken. You may feel a tug followed by a warm trickle or gush of fluid.
With prostaglandin, you might have some strong cramping as well. With oxytocin, contractions are usually more frequent and regular than in a labor that starts naturally.
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Risks and Precautions
Inducing labor is not like turning on a faucet. If the body isn't ready, an induction might fail and, after hours or days of trying, a woman may end up having a cesarean delivery (C-section). This appears to be more likely if the cervix is not yet ripe.
If the doctor ruptures the amniotic sac and labor doesn't begin, another method of inducing labor also might be necessary because there's a risk of infection to both mother and baby if the membranes are ruptured for a long time before the baby is born.
When prostaglandin or oxytocin is used, there is a risk of abnormal contractions developing.
In that case, the doctor may remove the vaginal insert or turn the oxytocin dose down. While it is rare, there is an increase in the risk of developing a tear in the uterus (uterine rupture) when these medications are used. Other complications associated with oxytocin use are low blood pressure and low blood sodium (which can cause problems such as seizures).
Another potential risk of inducing labor is giving birth to a late pre-term baby (born after 34 and before 37 weeks). Why? Because the due date (EDD) may be wrong. Your due date is 40 weeks from the first day of your last menstrual period (LMP).
Babies born late pre-term are generally healthy but may have temporary problems such as jaundice, trouble feeding, problems with breathing, or difficulty maintaining body temperature. They may also be more likely than full term babies to have developmental or school problems later on.
Even though inductions do come with risks, going beyond 42 weeks of pregnancy can be risky, too.
Many babies are born "post-term" without any complications, but concerns include:
- A vaginal delivery may become harder as the baby gets bigger. As babies get bigger, the chance of an injury during delivery, such as a broken bone, increases.
- The placenta that helps to provide the baby with nourishment is deteriorating.
- The amniotic fluid can become low or contain meconium — the baby's first feces. If the baby breathes in meconium, it can cause breathing problems.
Old wives' tales abound about ways to induce labor, such as the use of castor oil. It is not safe to try to artificially start labor yourself by taking castor oil, which can lead to nausea, diarrhea, and dehydration. And herbs and herbal supplements meant to induce labor can be harmful. Breast stimulation can cause uterine contractions by causing the release of oxytocin. However, some studies have suggested that the baby might have abnormal heartbeats after breast stimulation. Some women feel that having sex in late pregnancy can induce labor, but there is no conclusion on this yet.
Talk to your doctor before doing anything to try to encourage your little one's arrival. Inducing labor is best left to medical professionals — you may cause more harm than good.
As frustrating as it can be waiting for your baby to finally decide to arrive, letting nature take its course is often best, unless your doctor tells you otherwise. Before you know it, you'll be too busy to remember your baby was ever late at all!
Induced labour | Pregnancy Birth and Baby
What is an induced labour?
Labour normally starts naturally any time between 37 and 42 weeks of pregnancy. The cervix softens and starts to open, you will get contractions, and your waters break.
In an induced labour, or induction, these labour processes are started artificially. It might involve mechanically opening your cervix, breaking your waters, or using medicine to start off your contractions — or a combination of these methods.
In Australia, about 1 in 3 women has an induced labour.
What are the differences between an induced and a natural labour?
An induced labour can be more painful than a natural labour. In natural labour, the contractions build up slowly, but in induced labour they can start more quickly and be stronger. Because the labour can be more painful, you are more likely to want some type of pain relief.
If your labour is induced, you are also more likely to need other interventions, such as the use of forceps or ventouse (vacuum) to assist with the birth of your baby. You will not be able to move around as much because the baby will be monitored more closely than during a natural labour.
You will only be offered induced labour if there is a risk to you or your baby's health. Your doctor might recommend induced labour if:
- you are overdue (more than 41 weeks pregnant)
- there is a concern the placenta is not working as it should
- you have a health condition, such as diabetes, kidney problems, high blood pressure or pre-eclampsia
- the baby is making fewer movements, showing changes in its heart rate, or not growing well
- your waters have broken, but the contractions have not started naturally
- you are giving birth to more than one baby (twins or multiple birth)
Not everyone can have an induced labour.
It is not usually an option if you have had a caesarean section or major abdominal surgery before, if you have placenta praevia, or if your baby is breech or lying sideways.
Can I decide whether to have an induced labour?
If you are overdue, you might decide to wait and see if labour will start naturally. However, if there is a chance you or your baby are at risk of complications, you might need to consider induced labour before your due date.
When making your decision, discuss the risks and benefits with your doctor. Do not be afraid to ask lots of questions, such as:
- Why do I need an induction?
- How will it affect me and my baby?
- What will happen if I do not have the induction?
- What procedures are involved and how will you care for me and my baby?
You might need to consider several other health concerns. For example, there is a higher risk of stillbirth or other problems if your baby is not born before 42 weeks, and an increased risk of infection if your waters break more than 24 hours before labour starts.
What can I expect with an induced labour?
During the late stages of your pregnancy, your healthcare team will carry out regular checks on your health and your baby's heath. These checks help them decide whether it is better to induce labour or to keep the baby inside. Always tell your doctor or midwife if you notice your baby is moving less than normal.
If they decide it is medically necessary to induce labour, first your doctor or midwife will do an internal examination by feeling inside your vagina. They will feel your cervix to see if it is ready for labour. This examination will also help them decide on the best method for you.
It can take from a few hours to as long as 2 to 3 days to induce labour. It depends how your body responds to the treatment. It is likely to take longer if this is your first pregnancy or you are less than 37 weeks pregnant.
What options are there to induce labour?
There are different ways to induce labour. Your doctor or midwife will recommend the best method for you when they examine your cervix.
You may need a combination of different strategies. You will need to provide written consent for the procedure.
Sweeping the membranes
During a vaginal examination, the midwife or doctor makes circular movements around your cervix with their finger. This action should release a hormone called prostaglandins. You do not need to be admitted to hospital for this procedure and it is often done in the doctor's room. This can be enough to get labour started, meaning you will not need any other methods.
Risks: This is a simple and easy procedure; however, it does not always work. It can be a bit uncomfortable, but it does not hurt.
Oxytocin
A synthetic version of the hormone oxytocin is given to you via a drip in your arm to start your contractions. When the contractions start, the amount of oxytocin is adjusted so you keep on having regular contractions until the baby is born. This whole process can take several hours.
Risks: Oxytocin can make contractions stronger, more frequent and more painful than in natural labour, so you are more likely to need pain relief.
You will not be able to move around much because of the drip in your arm and you will also have a fetal monitor around your abdomen to monitor your baby.
Sometimes the contractions can come too quickly, which can affect the baby's heart rate. This can be controlled by slowing down the drip or giving you another medicine.
Artificial rupture of membranes ('breaking your waters')
Artificial rupture of membranes (ARM) is used when your waters do not break naturally. Your doctor or midwife inserts a small hook-like instrument through your vagina to make a hole in the membrane sac that is holding the amniotic fluid. This will increase the pressure of your baby's head on your cervix, which may be enough to get labour started. Many women will also need oxytocin to start their contractions.
Risks: ARM can be a bit uncomfortable but not painful. There is a small increased risk of a prolapsed umbilical cord, bleeding or infection.
Prostaglandins
A synthetic version of the hormone prostaglandins is inserted into your vagina to soften your cervix and prepare your body for labour.
It can be in the form of a gel, which may be given in several doses (usually every 6 to 8 hours), or a pessary and tape (similar to a tampon), which slowly releases the hormone over 12 to 24 hours. You will need to lie down and stay in hospital after the prostaglandins is inserted. You may also then need ARM if your waters have not broken, or oxytocin to bring on the contractions.
Prostaglandins gel is often the preferred method of inducing labour since it is the closest to natural labour. Tell your midwife or doctor straight away if you start to experience painful, regular contractions 5 minutes apart for your first baby, or 10 minutes apart for subsequent babies, or if your waters break, because these are both signs that your labour is beginning.
Risks: Some women find their vagina is sore after the prostaglandin gel, or they might experience nausea, vomiting or diarrhoea. These side effects are rare and there is no evidence that induction using prostaglandin is any more painful than a natural labour.
Very rarely, the contractions can come too strongly, which can affect the baby's heart rate. This can be controlled by giving you another medicine or removing the pessary.
You need to let your doctor or midwife know immediately if you start bleeding, or if your baby is moving less, because this could be a sign that something is wrong.
Cervical ripening balloon catheter
A cervical ripening balloon catheter is a small tube attached to a balloon that is inserted into your cervix. The balloon is inflated with saline, which usually puts enough pressure on your cervix for it to open. It stays in place for up to 15 hours, and then you will be examined again.
Tell your midwife or doctor straight away if you start to experience painful, regular contractions 5 minutes apart for your first baby, or 10 minutes apart for subsequent babies, or if your waters break, because these are both signs that your labour is beginning.
You may also need ARM or oxytocin if you are using a cervical ripening balloon catheter.
Risks: Inserting the catheter can be a bit uncomfortable but not painful.
You also need to let your doctor or midwife know immediately if you start bleeding, or your baby is moving less, because this could be a sign that something is wrong.
Can I have pain relief during induced labour?
Induced labour is usually more painful than natural labour. Depending on the type of induction you are having, this could range from discomfort with the procedure or more intense and longer lasting contractions as a result of the medication you have been given. Women who have induced labour are more likely to ask for an epidural for relief.
Because inductions are almost always done in hospital, the full range of pain relief should be available to you. There is usually no restriction on the type of pain relief you can have if your labour is induced.
Are there any risks with inducing labour?
There are some increased risks if you have an induced labour.
These include that:
- it will not work — in about 1 of 4 cases, women go on to have a caesarean
- your baby will not get enough oxygen and their heart rate is affected
- you or your baby get an infection
- your uterus tears
- you bleed a lot after the birth
What happens if the induction does not work?
Not all induction methods will work for everyone. Your doctor may try another method, or you might need to have a caesarean. Your doctor will discuss all of these options with you.
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Scientific induction and its methods. Logic in questions and answers
Scientific induction and its methods
Induction applied in conjunction with deduction is called scientific induction. In this case, inductive reasoning is supplemented by explanations based on laws or principles. For example: people in the past have repeatedly observed that heat is generated during friction.
However, the position: “During friction, heat arises” - began to be considered reliably scientific when this kind of phenomenon was explained on the basis of the laws of molecular physics.
Our knowledge of the world is impossible without determining the causal relationship between phenomena. Finding the causes of phenomena, we become able to control and manage them. Indispensable methods in this are the so-called methods of determining the causal relationship. They were developed and systematically expounded as early as the 19th century. English logician J. St. Mill. These methods are inductive, that is, they are inductive inferences. Here is their list:
1) single similarity method;
2) single difference method;
3) unified (combined) method of similarity and difference;
4) associated change method;
5) residual method.
Mill's main work "System of Logic" - written in 1843, the last Russian translation in 1914 - contains an inductivist interpretation of logic as a general methodology of sciences.
Our knowledge of the world is impossible without determining the causal relationship between phenomena, finding the causes of phenomena, we become able to control and manage them. Indispensable methods in this are the so-called methods for determining the causal connection (developed by the English logician J. Millem).
The methods are inductive, that is, they are inductive inferences.
It should be noted that causal connections are, of course, only a special kind of objectively existing connections, in particular, one side of the general interaction. At the same time, not every causal connection is at the same time regular, since random connections are also causally determined. Therefore, the possibilities of applying Mill's methods are limited. On the other hand, the establishment of causal relationships in nature and society is an important prerequisite for the knowledge of laws. The disclosure of causal relationships can also have direct practical significance.
Single match method . Suppose we want to determine the cause of the phenomenon a, which constantly occurs in a combination of such different circumstances: ABC, AED, ADE. We find that the only circumstance included in all combinations is A. Therefore, A is the cause of the phenomenon a. For example, we are interested in the question why the pendulums we have, made of different materials of different shapes and weights, have the same period of oscillation. When studying the issue, we find the only similarity in these pendulums: they have the same length. Consequently, the reason for the equality of the periods of oscillation of the pendulums is the equality of their lengths.
Single difference method . If a certain phenomenon occurs in connection with signs A, B, C, X and does not occur where there are only signs A, B, C, then we can conclude that X is the cause of E. Suppose that two enterprises have common signs, for example, they have the same equipment (A), the same number of skilled workers (B) and the availability of raw materials (C).
At an enterprise with great production successes, the material interest of the workers (X) is taken into account, but at another one it is not. Then, by induction, they conclude that material interest is the cause of higher production success.
Residue method . The application of the method is associated with the establishment of the cause that causes a certain part of a complex action, provided that the causes that cause other parts of this action have already been identified.
For example: in a criminal case on theft of goods from a warehouse, the accused admitted the fact of theft and testified that he alone took the stolen item out of the warehouse. The inspection carried out found that it was beyond the power of one person to carry such a thing by weight. The investigator came to the conclusion about the participation in the theft and other persons, in connection with which the qualification of the act also changed.
Accompanying change method .
If a change in the phenomenon a is observed only when the circumstance A changes, and is not observed when other circumstances change, then the conclusion is made that A is the cause of the phenomenon a. Thus, some sociologists argued that the social system is determined either by the geographical environment or by the growth in population density. However, the geographical environment in Great Britain and Japan, for example, is different, but the social system is the same. Population density is also different with the same social system. A change in the social order occurs when the mode of production changes. Therefore, a change in the mode of production is the cause of a change in the social order.
Conclusion: 1) when applying Mill's inductive methods, it should be taken into account that they can only be used to establish the causes of certain phenomena; 2) they can only in the rarest cases be used separately, in isolation from each other; 3) the method of similarity and difference is often combined; 4) the residual method illustrates the combined use of induction and deduction; 5) induction gives probable knowledge, so it is important to check everything in practice.
This text is an introductory fragment.
§ 5. INDUCTION AND DEDUCTION AS METHODS OF KNOWLEDGE
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3. Incomplete induction Incomplete induction is a conclusion about the entire class of objects as a whole based on the study of only a part of the objects of this class. The formula of incomplete induction: S1 - PS2 - P ... .. Sn - PS1, S2 ... Sn ... are part of the class S. Therefore, all S - R.B
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PARTIAL INDUCTION
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Basic types of scientific induction.
Scientific induction is called a conclusion in which generalization is built by selecting necessary and exclusion of accidental circumstances.
Depending on the research methods are: induction by selection (selection) and induction by the method of exclusion (elimination).
1. Induction method selection
Induction method selection, or selective induction, is conclusion, in which the conclusion about attribute belonging to a class (set) is based on knowledge of sample (subset) obtained methodical selection of phenomena from various parts of this class.
If in popular generalization proceed from the assumption of uniform distribution of the sign P in the class K and thus admit it transfer to K for simple repeatability (Si, 82,..., Sn), then in scientific induction K represents (and therefore considered) heterogeneous unequally distributed set R in its various parts.
When forming sample should diversify conditions observations.
Selection of P from various parts K must take into account the specifics, weight and importance to ensure representativeness, or representativeness, sample.
The concept of diversity conditions of observation is very different for specific types of sets. In one case, it takes on the character spatial visibility, another - temporary, in the third - functional, in the fourth - mixed.
An example of induction The selection method can be reasoning about the variety of winter sown wheat in one of the regions of Belarus. So, passing through the area, mark on course, which is in several areas (for example, in six) the fields are sown with one and the same variety of winter wheat. If on on this basis, to generalize that in all 15 districts, and therefore in the entire region the same variety is sown, it is obvious that what such a popular induction will give incredible conclusion.
Other case if the choice of the same number of districts will not be done by chance, along the way following, and taking into account the differences in their location and climatic conditions.
If the southern and northern regions are selected, internal and peripheral and at the same time the repeatability of the variety will be established, which means it is highly likely assume that the whole area uses the same variety of winter wheat.
credible the conclusion in this case is unlikely to be justified, since it is not excluded possibility of using another varieties in areas that are directly were not observed.
2. Induction method exceptions
Induction method exclusion, or eliminative induction, is a system of inferences in which conclusions about the causes of the studied phenomena are built by finding confirmatory circumstances and exceptions, not satisfying the properties of a causal connections.
Cognitive the role of eliminative induction - analysis causal connections. The reason is called such a connection between two phenomena, when one of them - the cause - precedes and causes another - action.
The most important properties of causation that predetermine methodical eliminative induction, features such as: universality, consistency in time, necessity and unambiguity.
Universality causality means that the world does not there are uncaused phenomena. Each the phenomenon has its cause, which may be detected sooner or later the research process.
Subsequence in time means that the reason is always precedes action. In some cases action follows cause instantly, in a matter of seconds. For example, a shot from a firearm happens as soon as the capsule will ignite cartridge. In other cases, the reason causes action over a longer period of time time interval. For example, poisoning poison can come in a few seconds, minutes, hours or days, depending on from the strength of the poison and the state of the body. AT social sphere, causal relationships can run for many months and years, in geology - the course of centuries and millennia.
Because the cause always precedes action, one of the many circumstances in the process inductive study are selected only those that have appeared before action of interest to us, and exclude from consideration (eliminate) arising simultaneously with it and appeared after him.
Subsequence in time is a necessary condition causation, but in itself it not enough to find the real the reasons. Recognition of this condition sufficient often leads to error, which is called "after this, then, because of this." Lightning, for example, tended to be the cause thunder because the sound is perceived later than the light flash, although this simultaneous events. AT investigative practice is sometimes mistaken interpret the fact as a causal connection threats by a certain person against another and subsequent violence against the personality of the second, although it is well known that threats are not always cited in execution.
causation differs in the property of necessity. This means that the action can be carried out only if there is a reason, the absence causes necessarily lead to lack of action.
unambiguous the nature of the causal relationship is manifested that each specific reason always evokes a very definite its corresponding action.
