Inducing labor options
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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Induction of labor or induction of labor
The purpose of this informational material is to familiarize the patient with the induction of labor procedure and to provide information on how and why it is performed.
In most cases, labor begins between the 37th and 42nd weeks of pregnancy. Such births are called spontaneous. If drugs or medical devices are used before the onset of spontaneous labor, then the terms "stimulated" or "induced" labor are used in this case.
Labor should be induced when further pregnancy is for some reason unsafe for the mother or baby and it is not possible to wait for spontaneous labor to begin.
The purpose of stimulation is to start labor by stimulating uterine contractions.
When inducing labor, the patient must be in the hospital so that both mother and baby can be closely monitored.
Labor induction methods
The choice of labor induction method depends on the maturity of the cervix of the patient, which is assessed using the Bishop scale (when viewed through the vagina, the position of the cervix, the degree of its dilatation, consistency, length, and the position of the presenting part of the fetus in the pelvic area are assessed). Also important is the medical history (medical history) of the patient, for example, a past caesarean section or operations on the uterus.
The following methods are used to induce (stimulate) labor:
- Oral misoprostol is a drug that is a synthetic analogue of prostaglandins found in the body.
It prepares the body for childbirth, under its action the cervix becomes softer and begins to open. - Balloon Catheter - A small tube is placed in the cervix and the balloon attached to the end is filled with fluid to apply mechanical pressure to the cervix. When using this method, the cervix becomes softer and begins to open. The balloon catheter is kept inside until it spontaneously exits or until the next gynecological examination.
- Amniotomy or opening of the fetal bladder - in this case, during a gynecological examination, when the cervix has already dilated sufficiently, the fetal bladder is artificially opened. When the amniotic fluid breaks, spontaneous uterine contractions will begin, or intravenous medication may be used to stimulate them.
- Intravenously injected synthetic oxytocin - acts similarly to the hormone of the same name produced in the body. The drug is given by intravenous infusion when the cervix has already dilated (to support uterine contractions).
The dose of the drug can be increased as needed to achieve regular uterine contractions.
When is it necessary to induce labor?
Labor induction is recommended when the benefits outweigh the risks.
Induction of labor may be indicated in the following cases:
- The patient has a comorbid condition complicating pregnancy (eg, high blood pressure, diabetes mellitus, preeclampsia, or some other condition).
- The duration of pregnancy is already exceeding the norm - the probability of intrauterine death of the fetus increases after the 42nd week of pregnancy.
- Fetal problems, eg, problems with fetal development, abnormal amount of amniotic fluid, changes in fetal condition, various fetal disorders.
- If the amniotic fluid has broken and uterine contractions have not started within the next 24 hours, there is an increased risk of inflammation in both the mother and the fetus. This indication does not apply in case of preterm labor, when preparation of the baby's lungs with a special medicine is necessary before delivery.
- Intrauterine fetal death.
What are the risks associated with labor induction?
Labor induction is not usually associated with significant complications.
Occasionally, after receiving misoprostol, a patient may develop fever, chills, vomiting, diarrhea, and too frequent uterine contractions (tachysystole). In case of too frequent contractions to relax the uterus, the patient is injected intravenously relaxing muscles uterus medicine. It is not safe to use misoprostol if you have had a previous caesarean section as there is a risk of rupture of the uterine scar.
The use of a balloon catheter increases the risk of inflammation inside the uterus.
When using oxytocin, the patient may rarely experience a decrease in blood pressure, tachycardia (rapid heartbeat), hyponatremia (lack of sodium in the blood), which may result in headache, loss of appetite, nausea, vomiting, abdominal pain, depression strength and sleepiness.
Induction of labor, compared with spontaneous labor, increases the risk of prolonged labor, the need for instrumentation
(use of vacuum or forceps), postpartum hemorrhage, uterine rupture, the onset of too frequent uterine contractions and the associated deterioration of the fetus, prolapse umbilical cord, as well as premature detachment of the placenta.
If induction of labor is not successful
The time frame for induction of labor varies from patient to patient, on average labor begins within 24-72 hours. Sometimes more than one method is required.
The methods used do not always work equally quickly and in the same way on different patients. If the cervix does not dilate as a result of induction of labor, your doctor will tell you about your next options (which may include inducing labor later, using a different method, or delivering by caesarean section).
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This informational material was approved by the Women's Clinic on 01/01/2022.
What you need to know about labor induction
Midwife, researcher with a wide and varied practice, Sarah Wickam, has released the book Induction of Labor: Making an Informed Decision in which she talks about induction of labor and provides important facts about the process. Consider ten important facts:
- Induced labor is different from spontaneous labor. The fact is that during natural childbirth, a special hormone is produced in the blood, which acts as an anesthetic. During induced labor, this hormone is not produced. A woman is injected with a synthetic hormone to stimulate the onset of labor, which causes severe pain. Induction of labor can have side effects, so the woman should be closely supervised.
- More pain
As mentioned above, childbirth is more painful. Contractions can be caused by prostaglandin helium or a balloon, in which case they can be very painful and strong. It is difficult for a woman to adapt to them.
- Side effects
When a woman decides whether to induce labor or wait, she needs to think about possible side effects. Injected drugs do not allow the woman's hormones to be produced. This can lead to problems for the mother and the baby. It is necessary to analyze how much labor stimulation is needed, because it will not be so easy to compensate for the harm of drugs.
- Detachment of membranes
In addition to the introduction of medications, there is another way to induce labor activity - to detach the membranes. This procedure causes discomfort, bleeding, and irregular contractions. In most cases, labor is induced only 24 hours earlier.
- Is there natural stimulation
There are two types of childbirth: either they start by themselves - natural childbirth, or we cause them in some way. There are no other ways. No matter how they are stimulated, it will not be natural stimulation.
- Is there a law to induce labor
There is no law that will force a woman to agree to labor induction. Of course, there are indications for artificial induction of labor in order to preserve the health or life of the baby, but the woman decides whether to agree to stimulation or not. Nobody can force. The doctor can only recommend.
- Just a small intervention
To calm a woman, midwives or doctors often say that they will only help a little, inject a drop of oxytocin. But oxytocin is a very serious drug, it should not be treated as some small droplet. This drug causes fetal distress. Some inject this drug until distress appears. Medicine is not to be underestimated.
- Unsuccessful stimulation
Attempts to induce labor are not always successful. There are times when these attempts do not lead to the desired result. A woman does not need to worry, everything is fine with her body, just the stimulation method used does not suit her.
- Risk of miscarriage
A study was made when there is a risk of stillbirth. Consider the received data:
Week 35 - Risk 1:500
Week 36 - Risk 1:556
Week 37 - Risk 1:645
Week 38 - Risk 1:730
Week 39 - Risk 1:800 9002 risk 1:926
41 weeks - risk 1:826
42 weeks - risk 1:769
43 weeks - risk 1:633
It is difficult to say from the data whether there is a benefit from inducing labor in some cases .
- Risks for old-timers
There is a point of view that as the age of a pregnant woman increases, the risk increases, so it is necessary to induce labor. According to some data, there is a relationship between a woman's age and the number of possible complications. The fact is that older women are more often examined, they may have health problems. Complications are more likely to occur due to health problems than due to age.
