While most women expect to welcome their little bundle of joy 38-40 weeks into their pregnancy, some may be thrown a curve ball and experience things a different way. If your labour doesn’t start on its own, your ob-gyn may use medications and other techniques for the induction of labour. If you are an expectant mom who wants to prepare for this potential scenario, here’s what you need to know.
Induction of Labour
The induction of labour is a procedure that is used to jump-start the labour process with the aim of delivering the baby vaginally. Letting nature take its course may be appropriate, but some patients may need some help to start things along.
What are the Reasons for an Induction of Labour?
During the course of your pregnancy, a variety of medical conditions may arise. These may put you or your baby at risk. These instances necessitate your ob-gyn to advise you to undergo an induction of labour, but only if there is no immediate danger to both mother and child. The maternal and fetal reasons behind this are the following:
- You are still pregnant a week or two past your due date.
- Your water breaks (ruptured amniotic membranes) but your labour doesn’t start on its own. Inducing your labour decreases the risks of infection to your uterus and your baby.
- You develop pre-eclampsia(a serious medical disorder caused by pregnancy and may manifest as high blood pressure)
- Your placenta is insufficiently nourishing the baby and growth is less than expected or the amniotic fluid is low.
- You previously had a full-term stillbirth.
- Diabetic mothers are commonly induced before their estimated date of delivery. Babies who are born to diabetic mothers are often larger (fetal macrosomia), and more prone to birth trauma hence an early delivery makes it less challenging. These babies also have a higher risk of stillbirth if they are not delivered by their due date, especially if there is poor sugar control by the mother.
- Women with a personal history of precipitous labour (i. e a very quick delivery) may be offered an induction of labour after 37 weeks of gestation.
- Intrauterine Growth Restriction (UGR). This means the baby is not growing to his/her full potential. Under the circumstance, it would be preferable to deliver the baby and provide nutrition externally.
- Premature rupture of membranes
- An infection inside the uterus known as chorioamnionitis
- Reduced fetal movements at term or a suspicious fetal heart trace pattern on monitoring
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What are The Different Methods for Inducing Labour?
Prostaglandin is applied vaginally in a pessary form. The most commonly used medication is Prostin or Cervidil.
This medication causes the softening of the cervix (or the neck of the womb) and it stimulates uterine muscle activity leading to labour. Once it is inserted, you will usually be required to stay in the hospital for monitoring. You will continue to rest in a lying position while the labour ward team monitor your uterine activity and your baby’s heart rate pattern.
After the insertion of the prostaglandin most women should feel comfortable and should be able to rest. However, if there is any fluid or blood leaking from your vagina, if you need any pain relief, or if you have other concerns, immediately let your midwife or doctor know.
Women respond differently to the medications. So, if your cervix doesn’t respond to the first dose of prostaglandin application, you may require further doses to allow your cervix to be ready for labour. However, the lowest dose is commonly used to prevent over-stimulation.
Oxytocin can stimulate uterine activity that is enough to produce cervical dilatation and fetal descent without compromising fetal health or risking the woman to uterine hyperstimulation when used with monitoring.
Oxytocin is first diluted before it is administered intravenously either continuously or titrated using an infusion device. The oxytocin levels needed to produce effective contraction vary among pregnant women, hence titration must be individualized. Since oxytocin has a short half-life in a mother’s blood, the drug concentration reduces rapidly averting potential over-stimulation.
2. Artificial Rupture of Membranes (AROM)
A mechanical way to induce labour involves the use of an amniohook or an amniotic membrane perforator, a specially designed instrument used to break a waterbag. The artificial rupture of membranes alone may induce or augment contractions in some women. The frequency of these contractions will then be monitored in the delivery suite, and if these are inadequate, an oxytocin infusion may have to be given.
3. Membrane sweep
Stripping the membranes involves sweeping a gloved finger over the thin membrane that connects the amniotic sac to the wall of the uterus. This action may cause your body to release prostaglandins which soften the cervix and may cause contractions. This is quite a natural way of encouraging more contractions to occur in the next few days.
4. Nipple Stimulation
This rather simple measure can actually help kick start labour. Rubbing or rolling your nipples can help release oxytocin. As mentioned earlier, oxytocin can help bring on full labour by making contractions longer and stronger. Generally, doctors use the drug Pitocin, which is a synthetic form of oxytocin to start things along.
It is important to note that this method of labour stimulation is only recommended for normal pregnancies. Always speak with your doctor before using nipple stimulation to induce labour to avoid problems like over-stimulation.
When using this method, always remember the following:
- Focus on one breast at a time.
- Limit the stimulation to only five minutes, and wait another 15 minutes before trying again.
- Pause nipple stimulation during contractions.
- Stop the stimulation when contractions become three minutes apart or less, one minute in length or longer.
Requirements for the Induction of Labour
- Labour can only be induced once the patient has been duly informed. They should receive an explanation regarding the indication of the procedure, the possible need for a Caesarean delivery, and other risks associated with induction.
- Fetal gestation is ascertained.
- It should only be performed in an environment where there are trained personnel and facilities are available to immediately deal with any potential complication.
Should a VBAC be induced?
In a 2010 VBAC Practice Bulletin No. 115 produced by the American Congress of Obstetrician & Gynecologists (ACOG):
Induction of labour for maternal or fetal indications remains an option for women undergoing TOLAC (trial of labor after caesarean). However, the potential increased risk of uterine rupture associated with any induction, and the potential decreased possibility of achieving VBAC, should be discussed.
In general, inductions for patients with a previous Caesarean section is not recommended as the risk of rupture increases by 2-3 fold compared to the naturally occurring spontaneous onset of labour.
Unsuitable Candidates for an Induction of Labour
- Induction of labour is not performed if you are unsuitable for a vaginal delivery.
- Women with a low-lying placenta
- Women whose baby is not lying head down.
- If you have had previous cesarean sections as the risk of uterine rupture increases
It is important for expectant women to talk with their doctors about their personal risks, concerns, and preferences. At the Dr. Pamela Tan clinic, we aim to offer women the proper guidance as you prepare for labour and delivery, with your needs in mind.
Book your consultation with us today.
Call us today at +65 6254 2878 to book an appointment with Dr Pamela Tan.