Labor induction

Labor Induction is a procedure performed by simulating uterine contractions, before the labor starts naturally. The doctor will determine various factors to see if labor induction is necessary or not. Some of the factors are as mentioned.

• Health condition of the fetus inside the womb.
• The position of the fetus in the uterus
• Gestational age and size of the baby
• The status and condition of the woman’s cervix

There are various reasons for labor induction. Some of these reasons are listed below:

• When the due date of the delivery has passed and usually when the woman is in 41^st and 42^nd week of pregnancy.
• Any history of still birth
• In cases, when the membranes have already ruptured or the water bags have broken but and still the labor has not started.
• If the expectant mother has some problems like hypertension (high blood pressure), preeclampsia or diabetes. Such problems, especially, during the phase of pregnancy may be a threat to the health of the baby.
• Uterine infections
• An increased heart rate of the fetus
• The insufficient amniotic fluid surrounding the fetus also known as oligohydramnios.
• Rh- blood problems
• The abnormal growth pattern of the fetus
• Deterioration of placenta has begun
• The abnormal or slow growth of the fetus suddenly
• Peeling off the placenta from the internal wall of the uterus, also known as placental abruption (peeling off completely or partially).

Usually, the process of the labor induction is safe but, in some cases, there might be some risks associated with it. Some of the risks, related to the procedure are as mentioned.

• Increased risk of C-section – Even after the process of inducing labor, if the baby is not delivered or the mother is not able to deliver the baby, then the doctor might go for the C-section surgery.
• Increased hospital stay – There are chances that even after the labor induction, there might be some problem in the delivery. In such cases, the pregnant woman might have to stay for a longer period of time in the hospital i.e. first for the labor induction but if it doesn’t work out, then for the C-section till the delivery is done.
• Risk of infection – Infections might happen if the delivery does not happen within a day or two of the labor induction by breaking or rupturing the amniotic sac. In such cases, there might be chances of infection in both fetus and the mother. This infection caused in the uterus due to the rupturing of amniotic fluid is known as chorioamnionitis.
• Decreased heart rate – When the medicines, like prostaglandins or oxytocin, are used to induce labor, mothers experience very strong uterine contractions. As a result, the oxygen supply of the fetus might slow down which may further decrease the heart rate.
• Problems with umbilical cord – In the process of labor induction, there is a risk of the umbilical cord slipping off into the woman’s vagina before the delivery. This issue is also known as umbilical cord prolapse. In such cases, the umbilical cord might get compressed and hence, reduce the oxygen supply to the fetus.
• Post- delivery bleeding – The labor induction process may make the muscles of the uterus weak leading to improper functioning or contraction, after the baby is delivered. This condition is also known as uterine atony and might result in severe bleeding after the woman has given birth.
• Premature birth in some cases, as a serious consequence of labor induction.
• Lung problems in the fetus
• Hearing and vision issues in the baby
• Underdeveloped brain and lungs of the baby.
• In some cases, the doctors do not advise a labor induction as it might cause some serious risks to either the mother or the fetus as mentioned below.
  • Placenta previa – This is a condition in which the placenta blocks the woman’s cervix.
  • Previous major C-section surgery on the uterus with a classical incision.
  • Active genital herpes infection in the pregnant woman.
  • Transverse fatal lie – This is a condition in which fetus lies in a crosswise position in the uterus.
  • A very narrow birth canal which might not be able to deliver the baby out normally even if labor induction is done.

The process of inducing labor is done in a hospital or a birth center where there is continuous monitoring of the mother and the baby, with all the specialties available. Preparations may include the following basic points:

• Firstly, the pregnant woman is asked to change into a hospital gown.
• The expecting mother is asked to avoid wearing any jewelry, nail polish or any kind of cosmetic
• The mother is advised to relax and calm down before the labor induction.

During the procedure:

Some of the procedures done for inducing labor are as mentioned.

• Stripping or sweeping the amniotic membranes – In this technique, the doctor puts the gloved finger into the vagina beyond the opening of the cervix. The physician then, rotates the finger to separate the uterine wall from the amniotic sac. This procedure does not actually induce labor in the woman but instead increases the speed of the starting phase of labor especially if the woman's cervix has already started to dilate. As a result, the woman might feel strong cramping and bleeding. In some scenarios, the bleeding might get severe than normal, and in such cases the doctor should be consulted immediately.

• Rupturing of amniotic sacs – This technique is also known as amniotomy and involves the rupturing of the amniotic membranes. In this procedure, the doctor creates small holes into the amniotic sac with the help of a fine plastic hook. This hook is inserted very carefully so that it does not harm the mother or the fetus in any way. The woman feels like a warm rush of fluid when the sac is opened. This technique is generally performed, if the head of the baby is deep in the pelvis or cervix of the woman. During this procedure, the heart rate of the fetus is monitored continuously. The doctor also examines and identifies for any traces of fecal waste in the amniotic fluid.

• Ripening the uterus – This procedure is conducted by using prostaglandins, a hormone in the form of medicine which helps in making the cervix of the pregnant woman soft, ripe and then, starts labor or uterine contractions. In this procedure, the prostaglandin is either taken orally or placed in the vagina along with the cervix. During this process, the heart rate of the fetus is also continuously monitored. Another technique to dilate the cervix is by the use of small catheters with a balloon tip. When this catheter with a balloon tip is placed beyond the cervix, liquid saline is pushed into the balloon part through the catheter, which causes the balloon to inflate, hence, leading to the dilation of the cervix. The dilator then absorbs all the moisture and become thick, resulting in cervix dilation.

• Intravenous medicines – This procedure is performed by using Oxytocin or Pitocin which is an intravenous medicine placed in the pregnant woman’s vagina to either induce labor or make the contractions stronger. The dose is adjusted accordingly by the doctor. During the procedure, the heart rate of the fetus is monitored continuously in order to ensure that the induced uterine contractions do not get strong enough to cause any harm to the fetus. In some cases, the oxytocin is not advised, if the tests show that the fetus is not getting sufficient oxygen and food already through the placenta. 

After the procedure:

The women might have to stay in the hospital for a longer time if the labor induction leads to C-section. The well-trained nurses take good care of the mother and the baby post- delivery. The labor induction cases may need a special care post-delivery.

The successful completion of induction of the labor results in the successful delivery of the baby. If the process of inducing labor fails to deliver the baby, it leads to the need for a C-section. If the induction of labor is performed before the 39^th week of pregnancy, the chances of complications are higher.

The doctor always advises waiting for the labor induction process, as close to the suggested due date as possible. If the woman has a normal vaginal delivery after labor induction, there might not be any harmful effect in future pregnancies. After the labor induction, if the C-section is needed, then the doctor might advise on whether to opt for repeated C-section or to attempt a normal vaginal delivery of the baby.