Induction of labour is a procedure for inducing uterine contractions through natural or medical methods with the goal of kick starting labour artificially before it begins naturally.
Why is Induction Done During Labour
Induction becomes necessary when the continuation of the pregnancy complicates or diminishes the mother and/or the baby’s well-being, posing a risk to their lives.
Some reasons for the mother may include:
- High blood pressure
- Severe infections
- Diseases like high blood sugar
- When the placenta separates
- When the water breaks prematurely
- When the pregnancy goes beyond 42 weeks
Some reasons for induction for the baby’s well being include the baby not growing well or when the baby dies before birth.
Other reasons are subjective to the mother’s preference for her birth plan and/or to the policies that govern the care provider’s practice. These may include:
- Due date
- Tired mother
- Choice of birth date
- Older first-time mother
- Twin pregnancy
A mother is not considered overdue unless she has completed 42 weeks of pregnancy. Induction of labour may be longer for first-time mothers and labour starts before term. Remember, any induction is induction. It is its effect that should be considered.
Types of Labour Inductions
Induction of labour can be done either through natural activities, such as exercising and having certain foods or medically through hormonal medication.
Natural Induction
Natural induction is a gentle way to help the body start labour. If the mother’s body is not ready, it might not give any effect but repeating the same method over and over may produce an effect eventually. Natural induction should be started after a minimum of 37 completed weeks of pregnancy to avoid premature labour. These include activities that occur naturally to the body like:
- Exercising: Activities such as walking, swimming, stretching exercises, kegels, and dancing help release endorphins and relax body muscles so labor can naturally occur.
- Relaxation: Massage and rest can help stimulate labor as it’s likely to start when the body is relaxed.
- Sex: Semen contain prostaglandin that prepares the cervix. Orgasming or intimate activities such as nipple stimulation during sex while pregnant produces oxytocin or ‘the love hormone’.
- Foods and herbs: Spicy food, pineapples, dates, raspberry leaf tea and many others are said to help induce labor
- Other methods: a bumpy car ride, acupuncture, acupressure, reflexology, and homeopathy are also quite effective for inducing labour.
Medical Induction
When the body initiates labour, it does so very gently. Initially, the contractions are mild, short and very spaced out. During this time, the body ensures that the cervix, which is the exit, is prepared for its role. Labour then progresses gradually until the baby is born.
Induction, on the other hand, can be immediate or can take hours to days depending on the body’s response.
Step 1: Preparing the Body
The process of induction tries to mimic the natural way of doing things starting with some general preparation. This includes stripping of membranes which is the separation of the bag of waters from the cervix. Some doctors will prescribe an enema to empty the bowels in an effort to stimulate contractions as the bowels move.
Step 2: Ripening of the Cervix
When the doctor asks you to check in for an induction, they usually first do a vaginal examination to check the state of your cervix. The first step is usually to help ‘ripen’ the cervix, making it soft, short, thin and ready to open, also known as effacement.
Naturally, the body produces prostaglandin to ripen the cervix but in the case of induction, a synthetic prostaglandin hormone in the form of a pessary is inserted into the vagina to initiate the ripening process. Some setups may use a pill to swallow or a gel to insert.
The goal is to allow the synthetic prostaglandin to stimulate the body so it can start producing the labour hormones too. A mother can get up to 3 pessaries repeated every 6 to 8 hours.
Step 3: Rupture of Membranes
Ideally, the induction process resumes when the cervix ripens or opens. The doctor or midwife then breaks the water bag using a small sterile tool. The procedure is not painful but may be uncomfortable. Your care provider will insert a hook that may be a few centimetres long or a small condom-like piece with a hook worn on one of the fingers. You’ll see or feel a gush of fluid to know that the bag has broken.
Doctors do this artificially for these reasons:
- To check if the water is clear: If the baby has done a fresh poop, sometimes depending on the care provider and policies in place, the induction process stops and a Caesarian section is performed. In some incidences, the induction continues but with the baby’s heartbeat continuously monitored to rule out distress.
- To allow the baby to move down: It’s assumed that when the bag is broken, it allows the baby to move down some more, making labour faster.
Step 4: Oxytocin Infusion
Synthetic Oxytocin hormone, also referred to as Syntocinon or Pitocin, is then administered via an intravenous infusion or drip. Oxytocin is the hormone the body produces to start contractions. The infusion is continued with the dose increasing every so often until it is time for the delivery.
Step 5: Monitoring
Doctors and nurses will monitor the baby’s heartbeat continuously or intermittently until delivery. They might also start a chart called a Partograph to record findings of the baby’s heartbeat, mothers blood pressure, and vaginal examinations.
Related: What Really Happens in the Delivery Room
Advantages of Labour Induction
- It averts the risks that were facing the baby and/or the mother
- It allows the baby to be born as per the schedule
- It reduces the waiting time before labour and birth
Risks associated with the Induction of Labour
While the induction of labour has its benefits for the mother and baby, there are still a few risks associated with the process:
- If a mother was not sure of the date of her last period, the baby may be born early, compromising their immediate lung and brain function.
- The body may reject the induction trigger especially if the natural hormones and preparation had not begun. If the cervix does not shorten, soften and thin, the chance of the birth ending up in a Caesarian is much higher.
- The risk of infection exists after the bag of water is broken. In about 70% of births, the bag breaks just about when the birth is about to happen.
- Breaking of waters may pose a risk of the cord falling out especially if the baby had not engaged. It also may delay the rotation of the baby’s head to the birth position.
- The oxytocin infusion makes contractions strong and more frequent and would require mums to have pain relief. The strong contractions may also tire the baby, reducing their heart rate, a situation referred to as Fetal distress and calls for a Caesarian birth.
- The infusion and monitoring reduces mother’s mobility which makes it difficult for her to use other coping strategies and reduces her use of gravity.
- Most inductions have time frames. This may put pressure on the mum and cause her anxiety. During labour, anxiety may cause tension, which inhibits relaxation and increases the pain.
- The strong and frequent contractions may make the uterus muscles tired and therefore slow in contracting after birth and this can lead to bleeding.
- Uterine rupture is a rare situation but can happen when the uterus gets overstimulated especially when there’s less or no close monitoring.
We hope this gives you a good description of what to expect if you choose to or need to induce labour for you and your baby’s wellbeing. At Malaica, your OB-GYN led delivery team walks with you every step of the way to see through the childbirth, whether you’re going the natural way, C-section, or need an induction.